Dose Delivery Analysis of Weekly Versus 3-Weekly Cisplatin Concurrent With Radiation Therapy for Locally Advanced Nasopharyngeal Carcinoma (NPC)
Dose Delivery Analysis of Weekly Versus 3-Weekly Cisplatin Concurrent With Radiation Therapy for Locally Advanced Nasopharyngeal Carcinoma (NPC)
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DOI：
10.1097/coc.0b013e31826b9b1a
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发表时间：
2014-02-01
影响因子：
2.6
通讯作者：
Ho, Cheryl
中科院分区：
文献类型：
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作者：
Jagdis, Amanda;Laskin, Janessa;Ho, Cheryl
目的：本研究的目的是分析一家三级肿瘤诊所每周一次的顺铂和每3周一次的大剂量顺铂的剂量分布和毒性。方法：2000年1月至2009年7月，鼻咽癌患者接受顺铂联合治疗性放射治疗。2005年前，大多数患者接受顺铂(Q3)(100 mg/m(2)静脉滴注，第1、22、43天)和三维适形放疗(66Gy33次)。2005年后，大多数患者接受每周一次的顺铂(Q1)(40 mg/m(2)，每周静脉滴注，疗程7wk)和调强放疗(70Gy，35次)。结果：73例患者中，Q1 45例，Q3 28例。Q1和Q3患者的累积剂量<gt；=200 mg/m(2)分别为80%和86%。Q1患者中有2/45(4%)的患者需要因毒性而减少剂量，而Q3患者中有11/28(39%)的患者需要因毒性而减少剂量(P=0.0003)。Q1和Q3患者的不良反应包括：急性毒性住院分别为20%和35.7%，平均体重下降10.85%和8.75%，经皮内窥镜胃造瘘管放置分别为25.6%和29.6%，3级脱水分别为11.1%和17.9%。Q1和Q3患者的中位随访时间分别为3年和6年。中位无瘤生存期Q1组为46个月，Q3组为53个月(P=0.667)。Q1和Q3的总生存期无差异。结论：顺铂每周40 mg/m(2)与每周100 mg/m(2)顺铂的缓释度、毒副作用和疗效相似。在我们的中心，每周顺铂是接受放化疗的局部晚期鼻咽癌患者的标准护理。
Objective: The purpose of this study was to analyze the dose delivery and toxicity of weekly cisplatin versus high-dose cisplatin given every 3 weeks in a tertiary oncology clinic.Methods: From January 2000 to July 2009, patients with biopsy-proven nasopharyngeal carcinoma receiving concurrent cisplatin with curative-intent radiation therapy (RT) were included. Before 2005, most patients received cisplatin (Q3) (100 mg/m(2) intravenously days 1, 22, and 43 of RT) and 3-dimensional conformal RT (66 Gy, 33 fractions). After 2005, most patients received weekly cisplatin (Q1) (40 mg/m(2) intravenously weekly for 7wk of RT) and intensity-modulated radiotherapy (70 Gy, 35 fractions).Results: Seventy-three patients were analyzed: 45 for Q1 and 28 for Q3. Cumulative doses >= 200 mg/m(2) were achieved in 80% of Q1 and 86% of Q3 patients, respectively. Dose reduction due to toxicity was required in 2/45 (4%) of Q1 patients compared with 11/28 (39%) of Q3 patients (P = 0.0003). Toxicities in Q1 and Q3 patients included: hospitalization for acute toxicity in 20% and 35.7%; mean weight loss 10.85% and 8.75%; percutaneous endoscopic gastrostomy tube placement in 25.6% and 29.6%; and grade 3 dehydration in 11.1% and 17.9%, respectively. Median follow-up time was 3 years for Q1 and 6 years for Q3 patients. Median disease-free survival was 46 months for the Q1 group and 53 months for the Q3 group (P = 0.667). There was no difference in overall survival between Q1 and Q3.Conclusions: In this series, weekly 40 mg/m(2) cisplatin and 3-weekly 100 mg/m(2) cisplatin showed similar deliverability, toxicity profiles, and outcomes. At our center, weekly cisplatin is standard of care for patients with locally advanced nasopharyngeal carcinoma undergoing chemoradiotherapy.