The Effect Of Chrono-chemotherapy Combined With Intensity Modulated Radiation Therapy On Quality Of Life And Nutritional Status Of Patients With Locally Advanced Nasopharyngeal Carcinoma

Objective:To observe the effect of chrono-chemotherapycombined with intensity modulated radiotherapy(IMRT)and conventional chemotherapy combined with intensity modulated radiotherapy(IMRT)on quality of life and nutritional status of patients with locally advanced nasopharyngeal carcinoma(NPC).The expected Chrono chemotherapy group than in conventional chemotherapy group can reduce the adverse reaction of patients with chemotherapy,patients have a relatively high quality of life and nutritional status,to provide a more reasonable treatment for patients with locally advanced nasopharyngeal carcinoma.Methods:85 patients with nasopharyngeal carcinoma were randomly divided into experimental group(n=42)and control group(n=43).The electronic automatic infusion pump intravenous chemotherapy pump infusion in fixed time test group induced chemotherapy and concurrent chemotherapy(induction chemotherapy:Docetaxel 03:30-04:30,intravenous infusion of cisplatin,D1;10:00-22:00,D1-5;5-continuous infusion of fluorouracil,22:00-10:00,continuous infusion,D1-5;chemotherapy:single drug cisplatin 10:00-22:00.Continuous infusion,D1);the control group using conventional methods(intravenous induction chemotherapy:Docetaxel infusion,intravenous infusion of cisplatin,D1;D1;5-fluorouracil continuous infusion,D1-5;chemotherapy:single drug cisplatin infusion,D1).Synchronous radiotherapy using intensity-modulated radiation therapy(IMRT),primary nasopharyngeal dose of T1-2:PGTVnx DT=69.96Gy/33f,T3-4:PGTVnx DT=73.92Gy/33f,PTVnx DT=69.96Gy/33f,PGTVnd DT=69.96Gy/33f,PGTVrpn DT=69.96Gy/33f,PTV1 DT=60.06Gy/33f,PTV2 DT=50.96Gy/28f.The quality of life of cancer patients in QLQ-C30 and EORTC scale for patients with head and neck cancer specific quality of life questionnaire EORTC QLQ-H&N35 and nutrition screening table NRS-2002 and patients with subjective self rating scale PG-SGA observed two groups of patients before and after chemotherapy and the life quality and nutritional status of the difference.SPSS 22 statistical analysis software package for data entry and statistical analysis.Results:Before treatment,the baseline data,quality of life and nutritional status of the two groups were compared,and there was no significant difference in clinical characteristics between the two groups(P>0.05).The comparison between groups:after 2 cycles of induction chemotherapy after the overall health of patients when chemotherapy and reduce gastrointestinal reactions(nausea and vomiting,loss of appetite,constipation,dysphagia,weight gain scores lower than the conventional group)was significantly better than the conventional chemotherapy group,the difference was statistically significant(P<0.05);the C.hrono chemotherapy group patients in fatigue,insomnia,pain score,shortness of breath,the field is lower than the conventional chemotherapy group,but the difference was not statistically significant(P>0.05).At the end of the concurrent chemotherapy and radiotherapy,the patients in the chemotherapy group were significantly better than those in the conventional chemotherapy group in the social function,the overall health status,and the reduction of nausea and vomiting,and the difference was statistically significant(P<0.05).The survey shows that 2002 NRS treatment before and after induction chemotherapy and concurrent chemoradiation in patients with nutritional risk rate were 8.24%,10.59%,83.53%;PG-SGA evaluation can be obtained before treatment and after induction chemotherapy and concurrent chemoradiation patients with malnutrition rate were 38.82%,69.41%,98.82%.The risk of malnutrition was significantly increased after treatment,but the results of the two evaluation results showed that the consistency was not good,and the sensitivity of PG-SGA was significantly better than that of NRS 2002.Conclusion:the quality of life of all patients was decreased after radiotherapy and chemotherapy.During the treatment of routine chemotherapy and conventional chemotherapy compared to alleviate the adverse reaction of nausea and vomiting,loss of appetite,constipation,so adjusting the time of chemotherapy for patients overall health and quality of life decreased significantly.Two quality of life questionnaire and two nutritional risk screening tables are easy to operate,and the feasibility is good.Compared with conventional chemotherapy,patients with locally advanced nasopharyngeal carcinoma may be a more reasonable treatment model.