BỘ GIÁO DỤC VÀ ĐÀO TẠO BỘ Y TẾ TRƯỜNG I HC Y H NI ============= LI MINH BCH ĐáNH GIá kết HóA xạ TRị TRƯớC Và HóA Xạ ĐồNG THờI carboplatin hàng tuần UNG THƯ BIểU MÔ VảY ĐầU Cổ GIAI ĐOạN IVA-IVB Chuyờn ngnh: Ung th Mó số: CK 62722301 LUẬN VĂN CHUYÊN KHOA CẤP II Người hướng dẫn khoa học: PGS.TS Ngô Thanh Tùng HÀ NỘI - 2018 LỜI CẢM ƠN Sau thời gian học tập công tác Trường Đại học Y Hà Nội, Bệnh viện K biết ơn kính trọng, em xin chân thành cảm ơn Các thầy, cô ban giám hiệu, môn ung thư trường Đại học Y Hà Nội Ban giám đốc bệnh viện K đồng nghiệp khoa xạ đầu cổ, khoa nội 2, khoa nội Qn Sứ giúp tơi hồn thành luận văn Đặc biệt, em xin bày tỏ lòng biết ơn sâu sắc tới: PGS.TS Ngô Thanh Tùng, người thầy trực tiếp hướng dẫn giúp đỡ em trình thực đề tài tận tình giúp đỡ em công việc sống; PGS.TS Nguyễn văn Hiếu, PGS.TS Lê văn Quảng giúp đỡ suốt trình học tập; Xin chân thành cảm ơn gia đình, bạn bè đồng nghiệp tạo điều kiện giúp đỡ nghiên cứu để hoàn thành đề tài này; Vợ con, lắng nghe, đồng cảm, động viên Tuy nhiên điều kiện lực thân hạn chế, chuyên đề nghiên cứu khoa học chắn không tránh khỏi thiếu sót Kính mong nhận đóng góp để nghiên cứu hoàn thiện Lại Minh Bách LỜI CAM ĐOAN Tôi Lại Minh Bách, học viên lớp chuyên khoa 2, chuyên ngành ung thư khóa 30, trường Đại học Y Hà Nội, xin cam đoan: Đây luận văn thân trực tiếp thực hướng dẫn PGS.TS Ngô Thanh Tùng Cơng trình khơng trùng lặp với nghiên cứu khác cơng bố Việt Nam Các số liệu thông tin nghiên cứu hồn tồn xác, trung thực khách quan, xác nhận chấp thuận sở nơi nghiên cứu Tơi xin hồn tồn chịu trách nhiệm trước pháp luật cam kết Hà Nội, ngày 02 tháng 09 năm 2018 Người viết Lại Minh Bách MỤC LỤC DANH MỤC BẢNG DANH MỤC BIỂU ĐỒ DANH MỤC HÌNH 10 ĐẶT VẤN ĐỀ Theo ước tính Hoa Kỳ, năm 2014 có 55.070 ca ung thư khoang miệng, họng, quản, chiếm 3% tổng số ca bệnh chẩn đoán khoảng 12.000 ca tử vong ung thư đầu cổ [1] Ung thư biểu mô vảy chiếm 90% thể mô bệnh học ung thư đầu cổ Khi bệnh giai đoạn tiến triển chỗ, vùng thường phải kết hợp phương thức điều trị Phẫu thuật cần xét định trước Nếu bệnh khơng định phẫu thuật cân nhắc: Xạ trị đơn triệt căn, hóa xạ đồng thời phác đồ có điều trị hóa chất cảm ứng (induction therapy) [2] Hiện nay, điều trị chuẩn cho ung thư biểu mơ vẩy vùng đầu cổ khơng mổ hóa xạ trị đồng thời hóa trị trước hóa xạ trị đồng thời [2] Theo hướng dẫn từ NCCN v 2.2017, pha hóa xạ đồng thời thường dùng hàng tuần carboplatin cetuximab Thử nghiệm lâm sàng pha III TAX 234 501 bệnh nhân ung thư biểu mô vảy (khoang miệng, họng miệng, quản, hạ họng) khơng mổ (T3,4 N2,3) chia hai nhóm Nhóm dùng hóa trị cảm ứng phác đồ TPF (Docetaxel, Cisplatin Fluorouracil) nhóm dùng phác đồ PF (Cisplatin, Fluorouracil) Sau đó, hai nhóm hóa xạ đồng thời với carboplatin hàng tuần xạ trị Thời gian theo dõi trung bình 72,2 tháng (95% CI 68,8-75,5) Sống thêm tồn tốt có ý nghĩa thống kê nhóm dùng TPF so với PF (hazard ratio [HR] 0,74; 95% CI 0,58-0,94), với sống thêm năm 52% nhóm dùng TPF 42% nhóm dùng PF Sống thêm trung bình 70,6 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