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目的比较紫杉醇(PTX)与甘氨双唑钠(CMNa)在鼻咽癌放疗中的增敏作用和不良反应。方法首程治疗的82例鼻咽癌患者,随机分为紫杉醇增敏组(PTX组)和甘氨双唑钠增敏组(CMNa组),在全程放疗中PTX组给予PTX 60 mg/m2静脉滴注(先给予地塞米松常规预处理),1次/10 d,共5次。CMNa组于每周1、3、5放疗前静脉滴注CMNa 0.75～1.0 g,连用7周。采用热塑面罩固定、低熔点挡铅的常规放疗方法放疗。结果放疗结束时及放疗后3个月2组患者的鼻咽部病灶及颈部转移病灶完全消退率均无明显差异。随诊5～50个月(中位20个月),PTX组的远处转移率(28.6%)低于CMNa组(50.0%),差异有统计学意义(P<0.05)。PTX组鼻咽及颈部复发率低于CMNa组,但差异无统计学意义(P>0.05)。PTX组2、3级口腔黏膜炎、白细胞减少较CMNa组明显,差异有统计学意义(P<0.01)。结论在放疗中加入低剂量PTX对局部晚期鼻咽癌的增敏作用与CMNa相当。前者能减少远处转移的发生,但增加了急性不良反应,特别是口腔黏膜炎和白细胞减少。
Objective To compare the sensitizing effects and side effects of paclitaxel (PTX) and glycopyrrolate sodium (CMNa) in radiotherapy of nasopharyngeal carcinoma. Methods Eighty-two patients with nasopharyngeal carcinoma (NPC) were randomly divided into paclitaxel sensitized group (PTX group) and glycopyrrolate sodium sensitized group (CMNa group). In the whole course of radiotherapy, PTX group was given PTX 60 mg / m2 vein Instillation (dexamethasone conventional pretreatment), 1/10 d, a total of 5 times. CMNa group 1,3,5 before weekly radiotherapy CMNa 0.75 ~ 1.0 g, once every 7 weeks. The use of thermoplastic mask fixed, low melting point block lead conventional radiation therapy. Results At the end of radiotherapy and 3 months after radiotherapy, the complete regression rate of nasopharyngeal lesions and neck metastases in two groups had no significant difference. The follow-up time ranged from 5 to 50 months (median 20 months). The distant metastasis rate in PTX group (28.6%) was lower than that in CMNa group (50.0%). The difference was statistically significant (P <0.05). The recurrence rate of nasopharynx and neck in PTX group was lower than that in CMNa group, but the difference was not statistically significant (P> 0.05). Grade 2 and 3 oral mucositis and leukopenia in PTX group were significantly higher than those in CMNa group (P <0.01). Conclusion The addition of low-dose PTX in radiotherapy sensitizes locally advanced nasopharyngeal carcinoma to CMNa. The former can reduce the incidence of distant metastases, but increased acute adverse reactions, especially oral mucositis and leukopenia.