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目的:探讨TPF方案诱导化疗结合同期调强放化疗治疗局部区域晚期鼻咽癌的有效剂量及近期疗效。方法:Docetaxel与DDP剂量60mg/m2,静脉滴入;5-FU初始剂量450mg/(m2.d),持续120h静脉灌注,按50mg/(m2.d)剂量递增,根据剂量递增法则确定其最大耐受剂量(MTD),观察终点为出现剂量限制性毒性(DLT)。每位患者行3个周期诱导化疗,每个周期化疗间隔3周,第3个周期化疗后3周给予调强放疗(IM-RT)加上同期DDP80mg/m2化疗。结果:12例患者共完成了450～550mg/(m2.d)3个剂量水平共34个周期诱导化疗。在550mg/(m2.d)剂量水平,1例患者出现3度黏膜反应及4度腹泻的DLT,按既定方案再以此剂量依次治疗3例患者,未再发生DLT,该剂量水平即为MTD。除1例DLT患者停止诱导化疗外,余11例患者均行3个周期诱导化疗,3个周期诱导化疗后总反应率(OR)100%,完全缓解率(CR)64%(7/11)。12例患者均完成同期放化疗,诱导化疗未加重同期放化疗的毒副反应。结论:TPF方案在Do-cetaxel60mg/m2、DDP60mg/m2剂量前提下治疗局部区域晚期鼻咽癌,5-FU的MTD为550mg/(m2.d),该方案具有较高近期反应率。
Objective: To investigate the effective dose and short-term efficacy of TPF induction chemotherapy combined with concurrent chemo-radiotherapy in the treatment of advanced nasopharyngeal carcinoma in the local area. Methods: Docetaxel and DDP were given intravenously at a dose of 60mg / m2 and intravenous drip at a dose of 450mg / (m2.d) for 120h. The dose of Docetaxel and DDP was increased by 50mg / (m2.d) Tolerance dose (MTD), end of observation for the emergence of dose-limiting toxicity (DLT). Each patient underwent 3 cycles of induction chemotherapy with an interval of 3 weeks for each cycle and IM-RT plus 80 mg of DDP for 3 weeks after the third cycle of chemotherapy. Results: 12 patients completed a total of 450 ~ 550mg / (m2.d) three dose levels of 34 cycles of induction chemotherapy. At the dose of 550mg / (m2.d), one patient developed 3 degree mucosal reaction and 4 degree diarrhea DLT, according to the established protocol and then treated with this dose in turn 3 patients, DLT no recurrence, the dose level is MTD . All but one of the patients with DLT discontinued induction chemotherapy, and the remaining 11 patients underwent three cycles of induction chemotherapy. The overall response rate (OR) was 100% and the complete response rate (CR) was 64% (7/11) after 3 cycles of induction chemotherapy. . All the 12 patients completed concurrent chemoradiotherapy and induced chemotherapy without any side effects of concurrent chemoradiotherapy. CONCLUSION: TPF regimen in the treatment of advanced nasopharyngeal carcinoma in the local area under the condition of Do-cetaxel 60mg / m2 and DDP 60mg / m2 dose has the highest MTD of 550mg / (m2.d).