Concurrent Weekly Cisplatin and Radiotherapy Plus Adjuvant Chemotherapy for Nasopharyngeal Cancer –A Preliminary Study

同步每週給予cisplatin合併放射線治療加上輔助性化學治療 對於鼻咽癌作用的初步研究結果

陳建安(Chien-An Chen) ； 張國華(Kou-Hwa Chang) ； 呂宜興(Yi-Shing Leu) ； 李振川(Jehn-Chuan Lee) ； 賴允亮(Yuen-Liang Lai) ； 陳昱君(Eu-Jun Chen) ； 鍾昌宏(Chang-Hung Chung) ； 陳裕仁(Yu-Jen Chen)

《放射治療與腫瘤學》 11卷1期 (2004/03) Pp. 9-15

https://doi.org/10.6316/TRO/200411(1)9

摘要

目的：已有研究顯示在局部晚期的鼻咽癌病患中，接受同步化學放射線治療者比單純接受放射線治療者有較好的存活率。為了強化放射線的效果，同時減少化學治療引起的毒性，我們使用低劑量的cisplatin作為同步化學放射線治療的藥物並評估其功效與毒性。 方法：共有14個符合條件的病患接受原發部位70~72 Gy的遠隔及3.5 Gy的腔內放射線治療，同時每週給予一次低劑量的cisplatin（30 mg/m2），共7到8週；在同步化學放射線治療之後給予4次的輔助性化學治療，每次每個月注射CDDP 20 mg/m2/day和5-FU 1000 mg/m2/24hs連續注射5天，並分析腫瘤反應與毒性。 結果：11位病患在8~10週之間，3位延後至11週完成同步化學放射線治療，一半的病患接受完整4週期的輔助性化學治療。10個病患（71.4%）在完成同步化學放射治療後有完全反應，另外三個在接受完整個治療計劃，包含同步化學放射治療與輔助性化療後達到完全反應。在同步化學放射治療期間，3個病人（21.4%）有3或4級的口咽黏膜炎，8個病人（57.1%）有3 或4級的放射性皮膚炎；在這個治療中，沒有發生嚴重的腎臟或致命的毒性。在19.5個月的中位數追蹤期中，1個病患仍有殘餘腫瘤，1個復發，2個有全身性轉移。 結論：同步化學放射線治療配合輔助性化療的治療計劃對於鼻咽癌病患有助益，且其急性毒性是可接受而且是可回復的，這種治療計劃的初步結果值得進一步用隨機分派的臨床計劃證實之。

關鍵字

鼻咽癌 ； 同步化學放射治療 ； 輔助性化療

並列摘要

Purpose : It has been shown that concurrent chemoradiotherapy (CCRT) confers significantly better survival in locally advanced nasopharyngeal carcinoma (NPC) compared with radiotherapy. We conducted a prospective pilot study to evaluate the efficacy and toxicity of a CCRT regimen using low-dose cisplatin (CDDP) for treatment of NPC to see if it enhanced radiation response and reduced chemotherapy-induced toxicity. Materials and Methods : A total of 14 patients were enrolled. The CCRT regimen consisted of radiotherapy (RT), 70~72 Gy to the primary tumor with concurrent CDDP 30 mg/m2 administered once a week for 7 to 8 weekly doses. After CCRT, 4 cycles of adjuvant CDDP, 20 mg/m2/day, and 5-FU, 1000 mg/m2 infused over 24 hours for 5 consecutive days were given monthly. Tumor response and toxicity were analyzed. Results : Eleven patients completed CCRT in 8 to 10 weeks, 3 patients delayed up to eleven weeks, and half (50%) received 4 complete courses of adjuvant chemotherapy. Ten (71.4%) patients had a complete response (CR) after CCRT, with an additional 3 achieving a CR after adjuvant chemotherapy, for a total of 13 (92.9%) out of 14. Adverse effects of CCRT included grade 3 or 4 oropharyngeal mucositis in 3 (21.4%) and grade 3 or 4 radiation dermatitis in 8 (57.1%). There was no severe renal or fatal toxicity from the treatment. At a median follow-up of 19.5 months, 1 patient still had residual tumor, 1 had recurrence and 2 had systemic metastases. Conclusion : CCRT followed by adjuvant chemotherapy was effective in a small series of NPC patients, with acceptable and reversible acute toxicity. This protocol deserves further investigation in randomized prospective trials.

並列關鍵字

nasopharyngeal carcinoma ； concurrent chemoradiotherapy ； adjuvant chemotherapy