国际肿瘤学杂志››2021,Vol. 48››Issue (1): 11-17.doi:10.3760/cma.j.cn371439-20201126-00002
中国医师协会放射肿瘤治疗医师分会, 中华医学会放射肿瘤治疗学分会, 中国抗癌协会肿瘤放射治疗专业委员会
收稿日期:2020-11-26修回日期:2020-12-08出版日期:2021-01-08发布日期:2021-01-21
Received:2020-11-26Revised:2020-12-08Online:2021-01-08Published:2021-01-21中国医师协会放射肿瘤治疗医师分会, 中华医学会放射肿瘤治疗学分会, 中国抗癌协会肿瘤放射治疗专业委员会. 同步放化疗期间应用聚乙二醇化重组人粒细胞刺激因子中国专家共识(2020版)[J]. 国际肿瘤学杂志, 2021, 48(1): 11-17.
表1
FN发生风险>20%的化疗方案及建议"
| 肿瘤类型 | 化疗方案 | 建议 | |
|---|---|---|---|
| 小细胞肺癌 | ①CDE方案(环磷酰胺+多柔比星+依托泊苷) | ||
| ②拓扑替康 | |||
| ③ICE方案(异环磷酰胺+卡铂+依托泊苷) | |||
| 非小细胞肺癌 | DC方案(多西他赛+卡铂) | ||
| 肿瘤类型 | 化疗方案 | 建议 | |
| 结直肠癌 | FOLFOXIRI方案(氟尿嘧啶+亚叶酸钙+奥沙利铂+伊立替康) | ||
| 食管癌和胃癌 | DCF方案(多西他赛+顺铂+氟尿嘧啶) | ||
| 胰腺癌 | FOLFIRINOX方案(奥沙利铂+亚叶酸+伊立替康+氟尿嘧啶) | ||
| 卵巢癌 | ①托泊替康 | ||
| ②紫杉醇 | |||
| ③多西他赛 | |||
| 头颈部肿瘤 | TPF方案(多西他赛+顺铂+氟尿嘧啶) | ||
| 乳腺癌 | ①TCH方案(多西他赛+卡铂+曲妥珠单抗) | ||
| ②ddAC-2wP方案(剂量密集多柔比星+环磷酰胺+序贯紫杉醇双周) | |||
| ③ddAC-2wP方案(剂量密集多柔比星+环磷酰胺+序贯紫杉醇单周) | |||
| ④TAC方案(多西他赛+多柔比星+环磷酰胺) | |||
| ⑤TE方案(多西他赛+表柔比星) | |||
| ⑥TC方案(多西他赛+环磷酰胺) | |||
| ⑦FEC方案(氟尿嘧啶+表柔比星+环磷酰胺) | |||
| ⑧高剂量多西他赛+噻替哌+卡铂联合 | |||
| ⑨高剂量多西他赛+噻替哌联合 | |||
| 肾癌 | 多柔比星+吉西他滨 | ||
| 睾丸癌 | ①VeIP方案(长春碱+异环磷酰胺+顺铂) | ||
| ②VIP方案(依托泊苷+异环磷酰胺+顺铂) | |||
| ③TIP方案(紫杉醇+异环磷酰胺+顺铂) | 建议预防性应用 | ||
| 膀胱癌 | 剂量密集的MVAC(甲氨蝶呤+长春碱+多柔比星+顺铂) | PEG-rhG-CSF | |
| 霍奇金淋巴瘤 | ①BEACOPP方案(博来霉素+依托泊苷+多柔比星+环磷酰胺+长春新碱+丙卡巴肼+泼尼松) | ||
| ②Brentuximabvedotin(维汀-布仑妥昔单抗)+AVD方案(多柔比星+长春碱+达卡巴嗪) | |||
| 非霍奇金淋巴瘤 | ①ICE方案(异环磷酰胺+卡铂+依托泊苷) | ||
| ②剂量调整的EPOCH方案(依托泊苷+泼尼松+长春新碱+环磷酰胺+多柔比星) | |||
| ③剂量密集的CHOP方案(环磷酰胺+多柔比星+长春新碱+泼尼松)±利妥昔单抗 | |||
| ④MINE方案(美司钠+异环磷酰胺、米托蒽醌+足叶乙甙) | |||
| ⑤DHAP方案(地塞米松+顺铂+阿糖胞苷) | |||
| ⑥ESHAP方案(依托泊苷+甲泼尼龙+顺铂+阿糖胞苷) | |||
| ⑦高剂量HyperCVAD方案(环磷酰胺+长春新碱+多柔比星+地塞米松)±利妥昔单抗 | |||
| 黑色素瘤 | ①以达卡巴嗪为主的联合方案(达卡巴嗪+顺铂+长春碱) | ||
| ②以达卡巴嗪为主联合IL-2、干扰素α的方案(达卡巴嗪+顺铂+长春碱+IL-2+干扰素α) | |||
| 骨肉瘤 | ①高剂量异环磷酰胺联合高剂量甲氨蝶呤 | ||
| ②多柔比星和顺铂(新辅助) | |||
| ③甲氨蝶呤、多柔比星和顺铂(初诊为高级别) | |||
| ④甲氨蝶呤、多柔比星和顺铂联合异环磷酰胺、依托泊苷(初诊为高级别) | |||
| ⑤顺铂动脉介入联合多柔比星静脉滴注 | |||
| ⑥顺铂动脉介入联合多柔比星、异环磷酰胺静脉滴注 | |||
| 软组织肉瘤 | ①MAID方案(美司钠+多柔比星+异环磷酰胺+达卡巴嗪) | ||
| ②标准剂量多柔比星或高剂量表柔比星 | |||
| ③异环磷酰胺和多柔比星 | |||
| 多发性骨髓瘤 | ①DT-PACE方案(地塞米松+沙利度胺+顺铂+多柔比星+环磷酰胺+依托泊苷) | ||
| ②VTD-PACE方案(DT-PACE方案+硼替佐米) | |||
表2
FN发生风险10%~20%的化疗方案、风险因素评估及建议"
| 肿瘤类型 | 化疗方案 | 风险因素评估 | 建议 |
|---|---|---|---|
| 小细胞肺癌 | ①CAV方案(环磷酰胺+多柔比星+长春新碱) | ①年龄>65岁并接受足剂量 强度化疗 ②既往接受过化疗或放疗 ③治疗前已经存在中性粒 细胞减少 ④肿瘤疾病累及骨髓 ⑤近期外科手术和/或开放性 创伤 ⑥肝功能障碍(胆红素> 20 mg/L) ⑦肾功能障碍(肌酐清除率< 50 mg/min) ⑧既往发生过FN ⑨恶性血液淋巴系统疾病 ⑩女性患者(小细胞肺癌) ⑪心血管疾病(非霍奇金淋巴瘤) |
若患者出现≥1项风险因素时,需要考虑给予预防性应用PEG-rhG-CSF |
| ②依托泊苷+顺铂/卡铂 | |||
| 非小细胞肺癌 | ①TP方案(紫杉醇+顺铂) | ||
| ②NP方案(顺铂+长春瑞滨) | |||
| ③DP方案(顺铂+多西他赛) | |||
| ④顺铂 | |||
| ⑤依托泊苷 | |||
| ⑥CP方案(卡铂+紫杉醇) | |||
| ⑦多西他赛 | |||
| 结直肠癌 | FOLFOX方案(氟尿嘧啶+亚叶酸钙+奥沙利铂) | ||
| 食管癌和胃癌 | ①伊立替康、顺铂 | ||
| ②表柔比星、顺铂、氟尿嘧啶 | |||
| ③表柔比星、顺铂、卡培他滨 | |||
| 胰腺癌 | FOLFIRINOX方案(奥沙利铂+亚叶酸+伊立替康+氟尿嘧啶) | ||
| 卵巢癌 | 卡铂和多西他赛 | ||
| 宫颈癌 | ①顺铂和托泊替康 | ||
| ②紫杉醇和顺铂 | |||
| ③托泊替康 | |||
| ④伊立替康 | |||
| 子宫肉瘤 | 多西他赛 | ||
| 乳腺癌 | ①含多西他赛的方案±曲妥珠单抗 | ||
| ②CMF方案(环磷酰胺+甲氨蝶呤+氟尿嘧啶) | |||
| ③AC-T方案(多柔比星+环磷酰胺序贯多西他赛,仅多西他赛治疗周期) | |||
| ④AC-TH方案(多西他赛序贯给药+曲妥珠单抗) | |||
| ⑤FEC-T方案(氟尿嘧啶+表柔比星+环磷酰胺序贯多西他赛) | |||
| ⑥紫杉醇21 d方案 | |||
| ⑦ddEC-T方案(剂量密集表柔比星+环磷酰胺序贯紫杉醇) | |||
| ⑧E-CMF方案(表柔比星序贯环磷酰胺+甲氨蝶呤+氟尿嘧啶) | |||
| ⑨XT方案(卡培他滨+多西他赛标准方案) | |||
| 睾丸癌 | ①依托泊苷和顺铂 | ||
| ②BEP方案(博来霉素+依托泊苷+顺铂) | |||
| 前列腺癌 | 卡巴他赛 | ||
| 非霍奇金淋巴瘤 | ①GDP方案(吉西他滨+地塞米松+顺铂)±利妥昔单抗 | ||
| ②CHOP方案(环磷酰胺+多柔比星+长春新碱+泼尼松)±利妥昔单抗,包括含聚乙二醇脂质体多柔比星替代多柔比星的治疗方案 | |||
| ③CHP方案(环磷酰胺+多柔比星+泼尼松)+本妥昔单抗 | |||
| ④苯达莫司汀 |
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