Wagner W, Hermann R, Hartlapp J, Esser E, Christoph B, Müller M K, Krech R, Koch O
Paracelsus-Strahlenklinik Osnabrück, Marienhospital Osnabrück, Germany.
Strahlenther Onkol. 2000 Feb;176(2):73-80. doi: 10.1007/pl00002331.
Hemoglobin levels are currently the focus of interest as prognostic factors in patients with head and neck cancer. Most published clinical trials have confirmed hemoglobin to possess a significant influence on survival in patients treated with radiotherapy. In our study we have investigated the prognostic value of hemoglobin in a combined modality schedule.
Forty-three patients with advanced head and neck tumors were treated with combined radio-chemotherapy. The therapy comprised 2 courses of induction chemotherapy with ifosfamide (1,500 mg/m2, day 1 to 5) and cisplatin (60 mg/m2, day 5) followed by hyperfractionated accelerated radiotherapy with a total dose of only 30 Gy. Surgery involved tumor resection and neck dissection.
The 1-year overall survival rate and the 2-year survival rate were 79% and 56%, respectively. The 1- and 2-year recurrence-free survival rates were 68% and 49%, respectively. Prognostic factors with an impact on survival were seen in tumor size (T3 vs T4, p = 0.0088), response to radio-chemotherapy at the primary site (no vital tumor rest vs vital tumor rest, p = 0.045), response to lymph node radio-chemotherapy (no vital tumor cells vs vital tumor cells, p = 0.013) and level of hemoglobin after radio-chemotherapy (Hb > or = 11.5 g/dl vs < 11.5 g/dl, p = 0.0084).
In our study hemoglobin level after radio-chemotherapy was identified for the first time to be also a significant prognostic factor (univariate analysis) in head and neck cancer patients who underwent combined radio-chemotherapy. Besides chemotherapy plus low-dose irradiation achieved similar results in comparison with radical resection and high-dose radiotherapy at least for the first 2 years after therapy. Relapsing disease could be treated with 1 additional course of radiotherapy which is supposed to be well tolerated.
血红蛋白水平目前是头颈癌患者预后因素的关注焦点。大多数已发表的临床试验证实血红蛋白对接受放疗的患者的生存有重大影响。在我们的研究中，我们调查了血红蛋白在综合治疗方案中的预后价值。
对43例晚期头颈肿瘤患者进行了放化疗联合治疗。治疗包括2个疗程的诱导化疗，使用异环磷酰胺（1500mg/m²，第1至5天）和顺铂（60mg/m²，第5天），随后进行超分割加速放疗，总剂量仅为30Gy。手术包括肿瘤切除和颈部清扫。
1年总生存率和2年生存率分别为79%和56%。1年和2年无复发生存率分别为68%和49%。影响生存的预后因素包括肿瘤大小（T3与T4，p = 0.0088）、原发部位对放化疗的反应（无存活肿瘤残留与有存活肿瘤残留，p = 0.045）、淋巴结放化疗的反应（无存活肿瘤细胞与有存活肿瘤细胞，p = 0.013）以及放化疗后血红蛋白水平（Hb≥11.5g/dl与＜11.5g/dl，p = 0.0084）。
在我们的研究中，首次确定放化疗后的血红蛋白水平也是接受放化疗联合治疗的头颈癌患者的一个重要预后因素（单因素分析）。此外，至少在治疗后的前2年，化疗加低剂量照射与根治性切除和高剂量放疗相比取得了相似的结果。复发性疾病可以再进行1个疗程的放疗，预计耐受性良好。
