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目的:研究适形调强放疗联合草酸铂(L-OHP)方案的新辅助化疗治疗局部晚期鼻咽癌的近期疗效和不良反应。方法:76例局部晚期鼻咽癌患者,抽签法随机分成L-OHP组38例,顺铂(DDP)对照组38例。两组均在诱导化疗2个周期后行放射治疗。L-OHP 130 mg/m2,静脉滴入,d1;亚叶酸钙(CF)100 mg/m2,静脉滴入,d1～d5;5-氟尿嘧啶(5-FU)500 mg/m2,静脉滴入,d1～d5。DDP30 mg/m2,静脉滴入,d1～d3,CF100 mg/m2,静脉滴入,d1～d5。放射治疗鼻咽部6～8周总剂量66～78 Gy/(30～39)次;颈部淋巴结6～8周总剂量60～70 Gy/(30～35)次;颈部5.5～6周预防剂量50～54 Gy。结果:L-OHP组有效率为57.9%,DDP组有效率为52.6%,差异无统计学意义;L-OHP组呕吐发生率(18.4%)显著低于DDP组(50.0%),P=0.003;L-OHP组肾毒性(7.9%)显著低于DDP组(34.2%),P=0.005;L-OHP组与DDP组血红蛋白、白细胞及血小板下降发生率分别为57.9%(52.6%)、60.5%(57.9%)和47.4%(42.1%),差异无统计学意义;神经毒性的发生率L-OHP组(57.91%)较DDP组(13.2%)高,差异有统计学意义(P<0.001),但患者可以耐受。结论:L-OHP治疗局部晚期鼻咽癌近期疗效与DDP相近,但L-OHP有较少的胃肠道反应和肾毒性发生,其毒副反应主要是L-OHP导致的外周神经毒性。
Objective: To investigate the short-term efficacy and adverse reactions of neoadjuvant chemotherapy with conformal intensity-modulated radiation plus oxaliplatin (L-OHP) in the treatment of locally advanced nasopharyngeal carcinoma. Methods: Totally 76 patients with locally advanced nasopharyngeal carcinoma were randomly divided into three groups: L-OHP group (38 cases) and cisplatin group (38 cases). Both groups underwent radiotherapy after 2 cycles of induction chemotherapy. L-OHP 130 mg / m2, intravenous infusion, d1; Calcium leucovorin (CF) 100 mg / m2, intravenous infusion, d1-d5; 5-fluorouracil 500 mg / d1 ~ d5. DDP30 mg / m2, intravenous infusion, d1 ~ d3, CF100 mg / m2, intravenous infusion, d1 ~ d5. Radiotherapy of the total dose of nasopharyngeal 6-8 weeks 66 ~ 78 Gy / (30 ~ 39) times; 6 to 8 weeks cervical lymph node total dose of 60 ~ 70 Gy / (30 ~ 35); neck 5.5 ~ 6 weeks Prevention dose 50 ~ 54 Gy. Results: The effective rate was 57.9% in L-OHP group and 52.6% in DDP group, the difference was not statistically significant. The incidence of vomiting in L-OHP group was significantly lower than that in DDP group (50.0%, P = 0.003 ; The nephrotoxicity (7.9%) in L-OHP group was significantly lower than that in DDP group (34.2%), P = 0.005; The incidences of hemoglobin, white blood cell and thrombocytopenia in L-OHP group and DDP group were 57.9% (52.6% (57.9%) and 47.4% (42.1%) respectively. The incidence of neurotoxicity in L-OHP group (57.91%) was higher than that in DDP group (13.2%), the difference was statistically significant ), But patients can tolerate. CONCLUSION: L-OHP has similar efficacy to DDP in the treatment of locally advanced nasopharyngeal carcinoma. However, L-OHP has less gastrointestinal and nephrotoxic effects and its toxicity is mainly peripheral neurotoxicity caused by L-OHP.