The Clinical Observation Of Regime In Locally Advanced Nasopharyngeal Carcinoma Patients:Tpf Induction Chemotherapy Combined Concurrent Chemoradiotherapy

Background The effcacy of locally advanced nasopharyngeal carcinoma is still poor,the local control rate of T3、 T4is70%,and the distant metastasis rate is20%-40%. Local recurrence and distant metastasis is still the main treatment failure pattern of nasopharyngeal carcinoma. The result of phase III randomized Intergroup study0099in North America showed that The3-year survival rate of the chemoradiotherapy group was only76%,then concurrent chemotherapy and radiotherapy plus adjuvant chemotherapy had become the standard treatment for locally advanced nasopharyngeal carcinoma. Along with the usage of intensity-modulated radiotherapy(IMRT),the regional control rate of NPC had been significantly improved,the local control rate of5-year has came up to90%,the overall survival rate of5year is70%,but the distant metastasis rate remain15%-25%,and a third of the distant metastasis happened with the original tumor controlled as well, improving the survival advantage of the space by the local control rate is getting smaller and smaller, meaning that distant metastasis is still the main pattern of failure of NPC.In order to improve the survival rate of locally advanced nasopharyngeal carcinoma, to find a different chemotherapy and new drugs bacomes the focus. The TPF induction chemotherapy which is composed of docetaxel and traditional PF regimen has been extensively studied on head and neck squamous cell carcinoma in foreign country.The induction chemotherapy plus concurrent chemotherapy and radiotherapy in the sequential treatment has gradually become the standard trearment of locally advanced unresecable head and neck cancer,but this induction chemotherapy has not been studied systematically in nasophaiyngeal carcinoma.To improve the distant metastasis-free,we start the preliminary clinical studies with TPF induction chemotherapy plus concurrent chemotherapy for locoregionally advanced nasophaiyngeal carcinoma.Objective:To observe the short-term efficacy and toxicity of the TPF induction chemotherapy plus concurrent chemotherapy in locoregionally advanced nasophaiyngeal carcinoma patients.Materials and Methods:41treatment-naive patients,with patients with locally advanced nasopharyngeal carcinoma from January2011to December2011were enrolled, and21TPF group,20PF group.In TPF group, the patients were given docetaxel on the first day,with the dose of70mg/m2,and the DDP80mg/m2dl to d3continuously,and as well as5-FU450-550mg/m2d1-5; meanwhile in PF group, the patients were DDP80mg/m2, dl-3, and5-FU,450-550mg/m2,d1-5.And after21days and performed another circle with the same regime.All of41patients only received one cycle induction chemotherapy and after this performance,intensity-modulated radiotherapy had followed,and during the irradiation cisplatin,80mg/m2for d1-3,2-3cycles, was given as a concomitant chemotherapy, also21days for a cycle. Result:The total effective rate of TPF group was100%,observed3months later when radiation had finished,and the CR of Nasopharynx was90.5%(19),PR9.5%(2); cervical lymph node was CR90%(18), PR10%(2), respectively.In the control group,:the total effective rate was100%, the CR of Nose pharynx was80%(16), PR20%(4), and the CR of cervical lymph node was82.4%(14), PR17.6%(3),respectively.The trend of local control rate in TPF group wasincreased,compared with the PF group,while the difference was not significant(P>0.05). For toxicity reaction,the occullrence rates of bone marrow suppression(especially neutropenia,P=0.006),vomit and atrichia (P=0.021and0.002) were higher in the TPF group generally,whereas were tolerable.Conclusion:The treatment regime for locoregionally advanced nasopharyngeal with TPF induction chemotherapy combined concurrent chemotherapy carcinoma was feasible,and obtained a better term efficacy,and the toxicity can be tolerated.