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目的 :探讨铂类治疗耐药的晚期、复发的鼻咽癌 ,应用吡喃阿霉素 (THP- ADM)、长春酰胺 (VDS)联合化疗方案进行治疗的疗效。方法 :共入选 35例铂类治疗耐药的晚期、复发的鼻咽癌患者 ,应用 THP- ADM及 VDS联合化疗方案进行治疗。具体用药为 THP- ADM5 0 mg/ m2 ,iv,dl;VDS3mg/ m2 ,iv,dl～ 5 ,每 3周重复疗程 ,每例至少化疗 2疗程。按 WHO标准评价疗效及毒性。结果 :32例可评价客观疗效病例中 ,9例获得 PR(2 8.1% ) ,其中 7例PR者为 DDP或卡铂继发耐药的病例 (有效率 35 .0 % ,7/ 2 0 ) ,另外 2例为对 DDP或卡铂原发耐药的患者 (16 .7% ,2 / 2 1) ,铂类继发耐药的病例似乎较原发耐药的患者有效率高 ,但无统计学差异 (P=0 .477)。有效病例的中位缓解期为 4.3个月 (范围 2～ 10 .6个月 )。主要不良反应是 、 级的骨髓抑制以及恶心、呕吐。结论 :该方案对铂类治疗耐药的晚期、复发的鼻咽癌患者有一定的治疗价值 ,且毒性较低 ,患者易耐受 ,值得进一步研究。
Objective: To investigate the efficacy of platinum-based chemotherapy for advanced and recurrent nasopharyngeal carcinoma treated with pirarubicin (THP-ADM) and vincristine (VDS) combined with chemotherapy. Methods: A total of 35 patients with advanced and recurrent nasopharyngeal carcinoma who were resistant to platinum treatment were enrolled. THP-ADM and VDS combined with chemotherapy were used for treatment. Specific medication for the THP-ADM5 0 mg / m2, iv, dl; VDS3mg / m2, iv, dl ~ 5, repeated every 3 weeks course of treatment, chemotherapy in each case for at least 2 courses. According to the WHO standard evaluation of efficacy and toxicity. Results: Among the 32 evaluable cases, PR (8.11%) were obtained in 9 cases, of which 7 cases were either DDP or carboplatin secondary resistant (effective rate was 35.0%, 7/20) (16.7%, 2/21) in the other two patients who were primary drug resistant to DDP or carboplatin. The cases of secondary platinum resistance seemed to be more effective than the primary drug resistance patients, but none Statistical differences (P = .477). The median effective response time was 4.3 months (range 2-10.6 months). The main adverse reactions were grade I bone marrow suppression as well as nausea and vomiting. Conclusion: This regimen has certain therapeutic value for patients with advanced and recurrent nasopharyngeal carcinoma which are resistant to platinum treatment, and the toxicity is low and the patients are easy to tolerate. Therefore, it is worth further study.