Efficacy and Adverse Effects of Chrono-chemotherapy Combined with Radiotherapy in Treating Nasopharyngeal Cancer_West China Medical Journal

Authors：

Bian Jie

Department of Oncology, Chang-an Branch of the First People’s Hospital of Liangshan Municipality, Xichang, Sichuan 615000, P. R. China;

Corresponding author：

Keywords：

鼻咽癌; 时辰化学疗法; 放射治疗

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【摘要】　目的　观察时辰化学疗法联合放射治疗对比常规化学疗法联合放射治疗对鼻咽癌的近期疗效及其不良反应。　方法　 2006年2月-2010年3月经病理学证实未接受过化学疗法的38例晚期鼻咽癌患者随机分为常规化学疗法联合放射治疗组（A组，n=20）和时辰化学疗法联合放射治疗组（B组，n=18）。两组均采用常规二维放射治疗。A组化学疗法方案为顺铂（DDP）80 mg/m2，采用完全水化方案，第1天静脉滴注；氟尿嘧啶800 mg/（m2•d），第2~6天120 h连续静脉滴注。B组时辰化学疗法采用Melodies多通道编程输液泵进行正弦曲线式时间调节给药。两组均为DDP 80 mg/m2，于10:00~22:00给药，浓度高峰设定在16:00；氟尿嘧啶800 mg/m2，于22:00~次日10:00给药，浓度高峰设定在凌晨4:00。每21天重复1次，行2~6疗程。　结果　 A组3程化学疗法后有效率（PR）为95%（19/20），全程结束完全缓解率（complete remission，CR）达75%（15/20）；B组在2程化学疗法后PR达100%，全程治疗结束CR达94.4%（17/18）。两组不良反应主要为迟发性血小板减少，发生率分别为35%（7/20）和22.2%（4/18），其他不良反应两组间无明显差别。　结论　时辰化学疗法联合放射治疗对晚期鼻咽癌在减轻化学疗法造成的血小板减少方面有明显的优势，值得临床推广应用以及进一步发掘时辰化学疗法在临床治疗的价值。
【Abstract】　Objective　 To investigate the efficacy and the adverse effects of routine chemotherapy and chrono-chemotherapy combined with radiotherapy for advanced nasopharyngeal cancer patients. 　Methods　 From March 2006 to March 2010, 38 patients diagnosed pathologically to have advanced nasopharyngeal cancer were randomly divided to the routine chemotherapy and radiotherapy group (group A, n=20) and the chrono-chemotherapy and radiotherapy group (group B, n=18). Patients in both groups received bi-dimensional radiotherapy. Patients in group A received a full hydration method, cisplatin (DDP) 80 mg/m2 intravenous infusion was also carried out on day 1; fluorouracil 800 mg/(m2•d) chemotherapy, and 120 hours of continuous intravenous infusion from day 2 to day 6. For patients in group B, Melodies multi-channel infusion pump programming to adjust the time of drug administering with a sinusoidal style was adopted; DDP 80 mg/m2 was administered intravenously on day 1 between 10:00 and 22:00 with the peak concentration set at 16:00; fluorouracil 800 mg/m2 was administered between 22:00 and 10:00 on the next day from day 2 to day 6 with the concentration peak set at 4:00. The treatments in both groups were repeated every 21 days, which was repeated for two to six courses of tremtment.　Results　 After three courses of treatment for group A, partial response (PR) rate was 95% (19/20), and after six courses of treatment, the complete remission (CR) rate was 75% (15/20); After two courses of treatment for group B, the PR rate was 100%, and after six courses of treatment, the CR rate was 94.4% (17/18). The main adverse effect was thrombocytopenia at an incidence rate of 35% (7/20) and 22.4% (4/18) in the two groups respectively. There was no obvious difference in other adverse effects between the two groups.　Conclusion　 Chrono-chemotherapy combined with radiotherapy for advanced nasopharyngeal carcinoma has obvious advantages in reducing thrombocytopenia caused by chemotherapy, and it is worth further exploring the clinical applications and values of chrono-chemotherapy.

Citation： Bian Jie. Efficacy and Adverse Effects of Chrono-chemotherapy Combined with Radiotherapy in Treating Nasopharyngeal Cancer. West China Medical Journal, 2011, 26(4): 510-512. doi: Copy

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1. 　Innominato PF, Lévi FA, Bjarnason GA. Chronotherapy and the molecular clock: Clinical implications in oncology[J]. Adv Drug Deliv Rev, 2010, 62(9-10): 979-1001.
2. 　Bernard S, Cajavec Bernard B, Lévi F, et al. Tumor growth rate determines the timing of optimal chronomodulated treatment schedules[J]. PLoS Comput Biol, 2010, 6(3): e1000712.
3. 　Lévi F, Karaboué A, Gorden L, et al. Cetuximab and circadian chronomodulated chemotherapy as salvage treatment for metastatic colorectal cancer (mCRC): safety, efficacy and improved secondary surgical respectability[J]. Cancer Chemother Pharmacol, 2011, 67(2): 339-348.
4. 　刘泰福, 徐国镇. 全国鼻咽癌会议纪要[J]. 中华放射肿瘤学杂志, 1992, 1(4): 204.
5. 　Therasse P, Arbuck SG, Eisenhauer EA, et al. New guidelines to evaluate the response to treatment in solid tumors. European Organization for Research and Treatment of Cancer, National Cancer Institute of the United States, National Cancer Institute of Canada[J]. J Natl Cancer Inst. 2000, 92(3): 205-216.
6. 　黄光武, 邝国乾. 实用鼻咽癌临床诊疗学[M]. 北京: 科学出版社, 2006, 192-194.
7. 　Liao C, Li J, Bin Q, et al. Chronomodulated chemotherapy versus conventional chemotherapy for advanced colorectal cancer: a meta-analysis of five randomized controlled trials[J]. Int J Colorectal Dis, 2010, 25(3): 343-350.
8. 　Geara FB, Glisson BS, Sanguineti G, et al. Induction chemotherapy followed by radiotherapy versus radiotherapy alone in patients with advanced nasopharyngeal carcinoma: results of a matched cohort study[J]. Cancer, 1997, 79(7): 1279-1286.
9. 　Bouchahda M, Adam R, Giacchetti S, et al. Rescue chemotherapy using multidrug chronomodulated hepatic arterial infusion for patients with heavily pretreated metastatic colorectal cancer[J]. Cancer, 2009, 115(21): 4990-4999.
10. 　杨兴龙, 任军. 时辰化疗联合常规放疗对晚期复发转移NPC的疗效观察[J]. 第四军医大学学报, 2001, 22(20): 1882-1885.
11. 　郭灵, 林焕新, 邱枋, 等. 5-Fu与DDP时间调节化疗治疗晚期鼻咽癌的初步临床观察[J]. 中国肿瘤临床, 2004, 31(13): 721-724.
12. 　金风, 欧阳金陵, 董红敏, 等. 鼻咽癌DDP+ 5-Fu/CF方案时辰化疗的临床前瞻性随机研究[J]. 中国肿瘤临床, 2004, 31(19): 1123-1125.

West China Medical Journal

Efficacy and Adverse Effects of Chrono-chemotherapy Combined with Radiotherapy in Treating Nasopharyngeal Cancer

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