Khảo sát độc tính và đáp ứng ban đầu của hóa xạ đồng thời bằng cisplatin trong điều trị ung thư đầu cổ tại Bệnh viện ung bướu TP. Hồ Chí Minh năm 2020

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Tác giả: Thị Minh Linh Nguyễn, Trung Hậu Nguyễn

Ngôn ngữ: vie

Ký hiệu phân loại: 616.994 +Cancers

Thông tin xuất bản: Tạp chí Y học Việt Nam (Tổng hội Y học Việt Nam), 2022

Mô tả vật lý: 41-53

Bộ sưu tập: Metadata

ID: 500538

Thêm vào giỏ

Khảo sát độc tính và đáp ứng ban đầu của hóa xạ đồng thời bằng cisplatin trong điều trị ung thư đầu cổ tại Bệnh viện Ung bướu Tp. Hồ Chí Minh năm 2020. Đối tượng, Phương pháp nghiên cứu: Nghiên cứu hồi cứu mô tả loạt ca: tất cả bệnh nhân carcinôm hốc miệng, khẩu hầu, thanh quản và hạ hầu giai đoạn III - IVb theo AJCC 8th đã được hóa xạ đồng thời bằng phác đồ cisplatin liều cao (100 mg/m2 da/03 tuần x 03 chu kì) hay cisplatin liều thấp (30 mg/m2 da/ tuần x 06 chu kì) tại khoa Xạ trị đầu cổ, tai mũi họng, hàm mặt Bệnh viện Ung Bướu Tp HCM từ 01/01/2019 - 31/12/2020. Kết quả: trong thời gian từ 01/01/2019 - 31/12/2020, chúng tôi thu nhận 83 đối tượng từ 02 nhóm điều trị hóa xạ đồng thời bằng cisplatin liều cao 100 mg/m2 da/ 03 tuần (n = 34) và cisplatin liều thấp (n = 49) 30 mg/m2 da/ tuần. Tỉ lệ đáp ứng hoàn toàn sau 06 tháng ở nhóm điều trị hóa xạ đồng thời với cisplatin liều thấp (73.47%) và nhóm cisplatin liều cao (82.35%) là không có khác biệt có ý nghĩa thống kê (p = 0.622). Về độc tính huyết học, hầu hết bệnh nhân ở hai nhóm điều trị chỉ ở mức độ nhẹ, không có trường hợp tử vong và chỉ có sự khác biệt tỉ lệ biến chứng giảm bạch cầu hạt độ 3 - 4 ở nhóm cisplatin liều cao (11.76%) lớn hơn so với nhóm cisplatin liều thấp (0%) (p<
0.05). Về biến chứng ngoài huyết học, bệnh nhân điều trị với cisplatin liều cao có tỉ lệ viêm loét niêm mạc miệng độ 3 (47.06%), viêm da độ 3 (11.76%) cao hơn so với nhóm cisplatin liều thấp với các tỉ lệ này lần lượt là 14.29% và 4.08% (p<
0.05). Kết luận: hóa xạ trị đồng thời với phác đồ cisplatin liều thấp có tỉ lệ đáp ứng hoàn toàn tại chỗ tại vùng sau 06 tháng tương đương với phác đồ cisplatin liều cao nhưng có tỉ lệ biến chứng cấp nặng thấp hơn đáng kể cũng như tỉ lệ hoàn tất điều trị cao hơn hứa hẹn sẽ là phương pháp thay thế tiêu chuẩn trong điều trị ung thư đầu cổ giai đoạn tiến xa tại chỗ tại vùng trong tương lai.To investigate toxicities and patient initial response to concurrent chemoradiotherapy with cisplatin in head and neck cancers at HCMC Oncology Hospital in 2020. Subject and method of study: A retrospective descriptive study included all patients with oral, oropharyngeal, laryngeal, and hypopharyngeal carcinoma stages III-IVb according to AJCC 8th who received concurrent chemoradiotherapy with a high-dose cisplatin regimen (100 mg/m2/3 weeks x 03 cycles) or low-dose cisplatin (30 mg/m2/week x 06 cycles) at the Department of Radiation Therapy of head, neck, ear, nose, throat, maxilla and face at Ho Chi Minh City Oncology Hospital from January 01, 2019 to December 31, 2020 Results: 83 patients were included in the study of which 34 patients were given concurrent chemoradiotherapy with high-dose cisplatin and 49 patients were given low dose cisplatin. The difference in the percentage of patients with complete response after 6 months in the low-dose cisplatin (73.47%) and high-dose cisplatin (82.35%) groups was not statistically significant (p = 0.622). Regarding hematologic toxicity, most patients in the two treatment groups experienced only mild adverse effects, without any deaths. The incidence of grade 3 - 4 agranulocytosis in the high-dose cisplatin group was statistically significantly higher than that of low-dose cisplatin group (11.76% and 0% respectively, p<
0.05). Regarding non-hematological complications, patients treated with high-dose cisplatin had a higher incidence of grade 3 oral mucositis (47.06% vs 14.29% ), grade 3 dermatitis (11.76% vs 4.08%) than that of the low-dose cisplatin group (p<
0.05). Conclusion: Concurrent chemoradiotherapy with low-dose cisplatin regimen had a locoregional complete response rate after 6 months similar to that of high-dose cisplatin regimen, but with significantly lower rates of severe acute complications as well as higher completion rates. It is going to be the potential standard of treatment of locally advanced head and neck cancer in the future.

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