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6.鐐轰繚闅滆叓鐦ゆ偅鍏�銆佹偅鍏掔洠(ji膩n)璀�(h霉)浜烘垨杩戣Κ灞€佹巿娆�(qu谩n)濮旀墭浜哄悎娉曟瑠(qu谩n)鐩�銆備富绠￠啱(y墨)璀�(h霉)浜哄摗鎳�(y墨ng)鍚戞偅鍏掔洠(ji膩n)璀�(h霉)浜烘垨杩戣Κ灞€佹巿娆�(qu谩n)濮旀墭浜鸿(shu艒)鏄庣梾鎯呭強娌荤檪鏂瑰紡銆佺壒娈婃不鐧傚強铏曠疆骞剁嵅寰楀叾鍚屾剰锛岃(shu艒)鏄庡収(n猫i)瀹规噳(y墨ng)鏈夎閷�銆傛噳(y墨ng)灞ヨ鏇�(sh奴)闈㈠悓鎰忔墜绾�(x霉)銆備繚璀�(h霉)鎮ｅ厭鐨勯毐绉佹瑠(qu谩n)锛屽皧閲嶆皯鏃忕繏(x铆)鎱ｅ拰瀹楁暀淇′话銆�

(浜�)娌荤檪鍘熷墖

1.NRSTS鐥呯悊椤炲瀷澶氭ǎ锛岀暟璩�(zh矛)鎬у挤(qi谩ng)锛岀敓鐗╁(xu茅)鐗规€у樊鐣板ぇ锛屽皪(du矛)鍖栫檪鏁忔劅鎬т笉鍚�锛岀洰鍓嶅湅(gu贸)闅涗笂鍏掔鍙婇潚灏戝勾NRSTS灏氱劇(w煤)瑕�(gu墨)鑼冩不鐧傜瓥鐣�銆傛(bi膩o)婧�(zh菙n)娌荤檪鏂规硶鍖呮嫭澶栫鎵嬭(sh霉)銆佹斁灏勬不鐧傘€佸寲鐧�銆佽瀵熴€侀澏鍚戞不鐧傚拰鍏嶇柅鐧傛硶銆�

2.娌荤檪绛栫暐鐐哄瀛�(xu茅)绉戣伅(li谩n)鍚堬紝鍦�(tu谩n)闅�(du矛)鍖呮嫭鍏掔鍜岃叓鐦ら啱(y墨)鐢�銆佹斁鐧傜銆佽(h霉)鐞�銆佺嚐(y铆ng)椁�(y菐ng)銆佸績鐞�銆佸悍寰�(f霉)绛夎€佸斧绲勬垚銆傚厭绔ヨ檿浜庣敓闀�(zh菐ng)鐧�(f膩)鑲叉湡锛屾不鐧備腑闂�(gu膩n)娉ㄧ殑閲嶉粸(di菐n)鏄浣曟渶澶ч檺搴﹀湴鎻愰珮娌荤檪鏁堟灉锛屽悓鏅�(sh铆)娓涘皯闀�(zh菐ng)鏈熷苟鐧�(f膩)鐧ュ拰涓嶈壇鍙嶆噳(y墨ng)锛岄噸瑕栫郴绲�(t菕ng)娌荤檪鍜岄暦(zh菐ng)鏈熼毃瑷€�

3.鐢变簬NRSTS鐧�(f膩)鐢熺巼浣�锛岀櫦(f膩)鐥呴儴浣嶅唬娉�锛屾墍浠ラ€欓儴鍒嗘偅鍏掑氨瑷鸿純鍒嗘暎锛岀洰鍓嶅湅(gu贸)鍏�(n猫i)鍠腑蹇冨ぇ妯ｆ湰鐥呬緥鏁�(sh霉)杓冨皯锛岀劇(w煤)澶氫腑蹇冭嚚搴婄爺绌剁祼(ji茅)鏋�銆傛湰寤鸿鎻愪緵鐨勬不鐧傚師鍓囧拰绱�(x矛)鍓囬噸榛�(di菐n)鍙冭€僀OG鏂规銆傛湰寤鸿鎻愪緵鐨勬不鐧傛柟妗堝悇閱�(y墨)闄㈡牴鎿�(j霉)鍚勮嚜鎯呮硜閬告搰鎳�(y墨ng)鐢ㄩ儴鍒嗙梾浜哄彲绲�(ji茅)鍚堟墍鍦ㄩ啱(y墨)闄㈠(sh铆)闅涙儏娉侀仼鐣�(d膩ng)鏀硅壇銆�

(涓�)缍滃悎娌荤檪鏂规

1.鎵嬭(sh霉)锛氭噳(y墨ng)浣滅偤棣栭伕鏂规銆�

(1)鎵嬭(sh霉)鑳藉惁鍒囬櫎鑵槫灏�(du矛)娌荤檪鑷抽棞(gu膩n)閲嶈锛屾墜琛�(sh霉)鍒囬櫎鐨勮寖鍦嶆垨鑵槫娈樼暀鐨勭▼搴︽槸褰遍熆鐢熷瓨鐨勮嚚搴婂洜绱�銆傛墜琛�(sh霉)鍒囬櫎鐨勫悓鏅�(sh铆)锛岀洝鍙兘淇濈暀鍣ㄥ畼鍜岃偄楂�銆傚皪(du矛)鏃╂湡灞€闄愭€ф儭鎬ц叓鐦�锛屾噳(y墨ng)瑕栫偤绶婃€ユ墜琛�(sh霉)銆傚皪(du矛)浜庨珨绌嶅皬锛岀敓闀�(zh菐ng)鎱�锛屼笉閫犳垚浠讳綍鐧ョ媭鐨勪綆搴︽儭鎬ц叓鐦�锛屽彲浠ュ畾鏈熸鏌�锛屼笉蹇呮€ヤ簬鎵嬭(sh霉)銆傚皪(du矛)浜庡法澶�銆佷镜鐘懆?ch膿)顚孧绻斿櫒瀹樻垨澶ц绠¤€屼笉鑳戒竴娆℃€ф墜琛�(sh霉)鍒囬櫎骞插噲鐨勮叓鐦�锛屾毇涓嶆墜琛�(sh霉)锛岀郸浜�2锝�3鍊�(g猫)鏈堣(sh霉)鍓嶅寲鐧�銆�

(2)鑵槫杓冨皬(≤5鍘樼背)鐨勬偅鑰�锛屽叏鍒囧悗鍒囩罚鐒�(w煤)娈樼暀锛岀劇(w煤)闇€鍚庣簩(x霉)娌荤檪銆傚皪(du矛)浜庢湁寰皬娈樼暀鐥呯伓鐨勬偅鑰�锛屾噳(y墨ng)琛岃紨鍔╂斁鐧�(鍖呮嫭璩�(zh矛)瀛愭斁鐧�)(5,580cGy)銆傚垏闄よ叓鐦よ純澶�(>5鍘樼背)鐨勬偅鑰�锛屽洜瀛樺湪灞€閮ㄥ拰鍏ㄨ韩寰�(f霉)鐧�(f膩)鐨勯ⅷ(f膿ng)闅�(xi菐n)锛屾噳(y墨ng)鑰冩叜杓斿姪鏀剧檪(5,580cGy)鍜屽寲鐧�銆�

(3)鐒�(w煤)娉曡鎵嬭(sh霉)鍒囬櫎鐨勬偅鑰呮噳(y墨ng)鍏堟帴鍙楀寲鐧�锛屼篃鍙(sh霉)鍓嶅悓鏅�(sh铆)鏀惧寲鐧�銆傚師鐧�(f膩)鑵槫4500cGy鏀剧檪銆傚琛�(sh霉)鍚庡瓨鍦ㄦ畼浣欒叓鐦�锛屾噳(y墨ng)灏�(du矛)鍘熺櫦(f膩)鐥呯伓鏀剧檪锛岃倝鐪兼畼鐣欒€�1980cGy;閺′笅娈樼暀鑰�1080cGy銆�

2.鍖栫檪锛氬皻鏈畬鍏ㄩ仈(d谩)鍒板叡璀�(sh铆)銆�

(1)鐩墠鐐烘娌�(m茅i)鏈夊ぇ瀹楃殑鐮旂┒鍫�(b脿o)鍛婅瓑瀵�(sh铆)鍖栫檪鍦∟RSTs鐨勪綔鐢�銆傛不鐧傛柟妗堜笉濡傛┇绱嬭倢鑲夌槫鐨勬槑纰�銆傝(sh霉)鍓嶅寲鐧傚彲鑳芥渻(hu矛)浣胯叓鐦ょ殑楂旂⿳娓涘皬銆佽渚涢殰绀�銆佸寘鑶滃鍘�锛岄倓鍙娇鑵槫鑸囨甯哥祫绻旂晫闄愯畩寰楁竻妤�锛岄檷浣庤叓鐦ょ牬瑁傝綁(zhu菐n)绉荤殑姗�(j墨)鐜�锛屾湁鍒╀簬鎵嬭(sh霉)瀹屾暣鍒囬櫎銆�

(2)闈跺悜娌荤檪鏄娇鐢ㄨ棩鐗╂垨鍏朵粬鐗╄唱(zh矛)鏀绘搳鐧岀窗(x矛)鑳炵殑涓€绋不鐧傛柟娉�銆傞€氬父姣斿寲鐧傛垨鏀剧檪灏�(du矛)姝ｅ父绱�(x矛)鑳炵殑鍗卞鏇村皬銆傚瑗跨传鏉夐唶鍜屽悏瑗夸粬璩撳柈钘ユ垨鑱�(li谩n)鍚堝寲鐧傚皪(du矛)涓€閮ㄥ垎NRSTs鏈夋晥銆�

3.鍖栫檪鏂规鎺ㄨ枽銆�

VAC(C锛氱挵(hu谩n)纾烽叞鑳�+V锛氶暦(zh菐ng)鏄ユ柊鍫�+A锛氭斁绶氳弻绱燚)鏂规锛歏CR锛�1.5mg/m²锛宒1銆乨8銆乨15;ACTD锛�1.5mg/m²(鏈€澶у姂閲�2.5mg)锛宒1;CTX锛�1.2g/m²锛�1h锛宒1(缇庡徃閳�360mg/(m²·娆�)锛孋TX0銆�3銆�6銆�9h)銆俈DC(V锛氶暦(zh菐ng)鏄ユ柊鍫�+D锛氶樋闇夌礌+C锛氱挵(hu谩n)纾烽叞鑳�):VCR1.5mg/m²锛宒1銆乨8銆乨15;ADR锛�30mg/(m².d)锛宒1锝瀌2;CTX锛�1.2g/m²锛�1h锛宒1銆侷E(I鐣扮挵(hu谩n)纾烽叞鑳�+E渚濇墭娉婅嫹)鏂规锛欼FO锛�1.8g/(m².d)锛宒1锝瀌5(缇庡徃閳�360mg/(m².娆�)锛孖FO0銆�3銆�6銆�9h);VP16锛�100mg/(m².d)锛宒1~d5銆�

娉細≤12kg鎸夐珨閲嶈▓(j矛)绠�锛屽姂閲�=楂旇〃闈㈢⿳鍔戦噺/30×楂旈噸(kg)

鍏�銆佹不鐧傜浉闂�(gu膩n)姣掑壇鍙嶆噳(y墨ng)鐩�(ji膩n)娓�(c猫)鍙婅紨鍔╂不鐧�

(涓€)钘ョ墿杩戞湡姣掓€х洠(ji膩n)娓�(c猫)鍙婅紨鍔╂不鐧�

鍖栫檪钘ョ墿杩戞湡姣掓€т富瑕佽〃鐝�(xi脿n)鍦ㄨ娑�銆佸績銆佽偤銆佽倽銆佽厧鍜岃叇绛�(闄勮〃5)锛岃伅(li谩n)鍚堢敤钘ユ檪(sh铆)锛屾噳(y墨ng)娉ㄦ剰鍔犲挤(qi谩ng)灏�(du矛)鑵槫绱�(x矛)鑳炵殑娈哄偡鍔涜€屼笉澧炲姞钘ョ墿鐨勬瘨鎬т綔鐢�銆傚湪鐢ㄨ棩閬�(gu貌)绋嬩腑锛岄櫎娉ㄦ剰澧炲挤(qi谩ng)鐕�(y铆ng)椁�(y菐ng)锛岃(b菙)鍏呯董鐢熺礌锛岄槻娌绘按鍜岄浕瑙ｈ唱(zh矛)绱婁簜锛岀煰姝ｈ钵琛€锛屾帶鍒跺拰閬垮厤浜ゅ弶鎰熸煋澶�锛屽苟鏍规摎(j霉)鍖栫檪钘ョ墿鎬ユ€у強浜炴€ユ€ф瘨鎬у弽鎳�(y墨ng)锛屽楠ㄩ珦鎶戝埗鍙婅儍鑵搁亾鍙嶆噳(y墨ng)绛�锛屽姞寮�(qi谩ng)鏀寔鍜屽皪(du矛)鐧ユ不鐧�銆�

鏈夌殑钘ョ墿閭勬湁鐗圭暟鎬у壇浣滅敤锛屽闀�(zh菐ng)鏄ユ柊鍫垮彲寮曡捣鑵搁夯鐥瑰拰渚跨锛岄樋闇夌礌鍙紩璧峰績鑷熸悕瀹�锛屽潎闋堟敞鎰忔娓�(c猫)鍜岄爯(y霉)闃�銆�

1.蹇冭嚐姣掓€�:涓昏鎸囪捊鐠�(hu谩n)椤炶棩鐗╃殑蹇冭嚐姣掓€�锛屽寘鎷€ユ€у績鑲屾悕鍌峰拰鎱㈡€у績鍔熻兘鎼嶅銆傚墠鑰呯偤鐭毇鑰屽彲閫嗙殑蹇冭倢灞€閮ㄧ己琛€锛屽彲琛ㄧ従(xi脿n)鐐哄績鎱�銆佹埃鐭�銆佽兏鎮�銆佸績鍓嶅崁(q奴)涓嶉仼绛�;鍚庤€呯偤涓嶅彲閫嗙殑鍏呰鎬у績鍔涜“绔紝鑸囪棩鐗╃疮绌嶅姂閲忕浉闂�(gu膩n)銆�

涓€鏃﹀績鍔熻兘妾㈡脯(c猫)鎻愮ず蹇冭嚐灏勮鍒�?j菒n)?sh霉)<55%鎴栬桓绺煭鍒�?j菒n)?sh霉)<28%锛岃嫢鑳借瓑鏄庡乏蹇冨姛鑳界暟甯稿拰绱�(x矛)鑿屾劅鏌撴湁闂�(gu膩n)锛屽彲浠ョ辜绾�(x霉)浣跨敤钂界挵(hu谩n)椤炴姉鐢熺礌锛屽惁鍓囨噳(y墨ng)瑭叉毇鍋�锛岀洿鍒板皠琛€鍒�?j菒n)?sh霉)≥55%鎴栬桓绺煭鍒�?j菒n)?sh霉)≥28%銆傛牴鎿�(j霉)钂界挵(hu谩n)椤炶棩鐗╀娇鐢ㄥ姂閲忔垨蹇冭倢鎼嶅偡绋嬪害閬告搰鍙充笝浜炶兒(Zinecard)锛屽乏鏃嬭倝鍫�銆佽兘閲忓悎鍔戠瓑钘ョ墿銆�

2.杞�(zhu菐n)姘ㄩ叾鍗囬珮:ALT/AST閬�(d谩)姝ｅ父楂橀檺10鍊嶆垨浠ヤ笂鏅�(sh铆)鍙欢绶╁寲鐧�锛�1鍛ㄥ悗浠嶆湁鐣板父鑰呭彲浠ュ湪鍤�(y谩n)瀵嗚瀵熶笅鍖栫檪銆�

3.闀�(zh菐ng)鏄ユ柊鍫�:闀�(zh菐ng)鏄ユ柊鍫垮柈娆″姂閲忎笉寰楄秴閬�(gu貌)2mg銆傚父瑕�(ji脿n)鐨勮紩搴︽瘨鎬ф湁涓嬮牅鐤肩棝銆佷究绉樸€佹繁鍙嶅皠娓涘急銆傛湁鏅�(sh铆)鍙互鏈夌櫦(f膩)鑱查殰绀欍€傚嚭鐝�(xi脿n)鐩茶吀鐐庤€呮噳(y墨ng)鍋滆棩銆傞憭浜庣洰鍓嶇劇(w煤)闀�(zh菐ng)鏄ュ湴杈涜垏闀�(zh菐ng)鏄ユ柊鍫垮湪娌荤檪鐧傛晥鐨勯毃姗�(j墨)灏�(du矛)鐓�?q菒ng)?b脿o)鍛婏紝闄や互涓婃儏娉佸寤鸿棣栭伕鍦�(gu贸)闅涘叕瑾�(r猫n)钘ョ墿闀�(zh菐ng)鏄ユ柊鍫�銆�

4.SMZco闋�(y霉)闃插崱姘忚偤鍥婅煵(ch贸ng)鎰熸煋:寤鸿闀�(zh菐ng)鏈熸湇鐢⊿MZco闋�(y霉)闃插崱姘忚偤鍥婅煵(ch贸ng)鎰熸煋锛�25mg/(kg.d)锛屽垎鍏╂锛屾渶澶у姂閲忔瘡娆�0.5g锛孊id锛屾瘡鍛�3澶�銆傜洿鍖栫檪绲�(ji茅)鏉熷悗2锝�3鏈�銆�

5.琛€鍒跺搧杓告敞:璨ц涓€鑸彲浠ラ€氶亷(gu貌)杓告敞绱呯窗(x矛)鑳炵珐瑙ｈ钵琛€锛岃绱呰泲鐧�<60g/L蹇呴爤杓告敞銆傝灏忔澘娓涘皯锛氳灏忔澘瑷�(j矛)鏁�(sh霉)<20×10⁹/L鏅�(sh铆)鎳�(y墨ng)杓告敞琛€灏忔澘锛屼即鏈夋槑椤嚭琛€鐧ョ媭鎴栨劅鏌撹〃鐝�(xi脿n)鏅�(sh铆)

杓告敞鎸囧緛鍙仼鐣�(d膩ng)鏀惧銆�

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