三周方案与每周方案顺铂同步放化疗治疗鼻咽癌的疗效与毒性比较

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中文摘要

本回顾性研究比较了三周方案与每周方案顺铂同步放化疗在既往未治疗、活检证实的鼻咽癌患者中的疗效与毒性，这些患者接受了根治性同步放化疗后辅助化疗。排除远处转移、Karnofsky体能状态<80、诱导化疗或未接受辅助治疗的患者。回顾了2000年6月至2023年6月期间治疗的205例患者的医疗记录。患者接受三周方案顺铂（100 mg/m2，每3周一次[第1天和第2天各50 mg/m2，每21天重复]）或每周方案顺铂（40 mg/m2），放疗剂量为70 Gy/35次或69.96 Gy/33次。采用Kaplan-Meier法和Cox比例风险模型分析治疗结局，采用卡方检验比较毒性特征。中位随访76个月后，10年总生存率为76.5%。三周方案组累积顺铂剂量更高（263.9±50.1 vs. 247.8±35.4 mg/m2，p=0.0107），而每周方案组中年龄>50岁的患者更多（63.2% vs. 46.6%，p=0.0338）。三周方案组与每周方案组在总生存（p=0.9096）和无进展生存（p=0.9186）方面无显著差异。每周顺铂组1-2级低镁血症发生率更高（p=0.0415）。其他急性毒性，包括胃肠道、肾脏、血液学、耳科、神经系统和电解质毒性，以及治疗后1年肾损伤、听力障碍、耳鸣和周围神经病变，两组间相当。这些发现表明，在根治性同步放化疗后辅助化疗的鼻咽癌患者中，三周方案与每周方案顺铂的生存结局和毒性特征相似。

英文摘要

This retrospective study compared the efficacy and toxicity of concurrent triweekly versus weekly cisplatin in patients with previously untreated, biopsy-proven NPC who received definitive CRT followed by adjuvant chemotherapy. Patients with distant metastasis, Karnofsky Performance Status < 80, induction chemotherapy, or no adjuvant therapy were excluded. Medical records of 205 patients treated between June 2000 and June 2023 were reviewed. Patients received triweekly cisplatin (100 mg/m2 every 3 weeks [administered as 50 mg/m2 on days 1 and 2 every 21 days]) or weekly cisplatin (40 mg/m2), with radiotherapy to 70 Gy/35 fractions or 69.96 Gy/33 fractions. Treatment outcomes were analyzed using the Kaplan-Meier method and Cox proportional hazards model, while toxicity profiles were compared using the chi-square test. After a median follow-up of 76 months, the 10-year overall survival rate was 76.5%. The cumulative cisplatin dose was higher in the triweekly group (263.9 ± 50.1 vs. 247.8 ± 35.4 mg/m2, p = 0.0107), while the weekly group included more patients older than 50 years (63.2% vs. 46.6%, p = 0.0338). No significant differences were observed between the triweekly and weekly groups in overall survival (p = 0.9096) and progression-free survival (p = 0.9186). The weekly cisplatin group exhibited a higher incidence of Grade 1-2 hypomagnesemia (p = 0.0415). Other acute toxicities, including gastrointestinal, renal, hematologic, otologic, neurologic, and electrolyte toxicities, as well as 1-year post-treatment kidney injury, hearing impairment, tinnitus, and peripheral neuropathy, were comparable between groups. These findings demonstrate similar survival outcomes and toxicity profiles between concurrent triweekly and weekly cisplatin regimens in NPC treated with curative CRT followed by adjuvant chemotherapy.