Corry J, Rischin D, Smith J G, D'Costa I A, Huges P G, Sexton M A, Sizeland A, Lyons B, Peters L J
Division of Radiation Oncology, Peter MacCallum Cancer Institute, St. Andrews Place, East, Melbourne, Australia.
Radiother Oncol. 2000 Feb;54(2):123-7. doi: 10.1016/s0167-8140(99)00182-6.
The aim of this study was to review our experience with a treatment regimen that combined conventionally fractionated radiation therapy (70 Gy over 7 weeks) with chemotherapy (cisplatin and fluorouracil), given concurrently in the last 2 weeks of radiation therapy in patients with previously untreated advanced squamous cell cancer of the head and neck region.Twenty-eight patients, all but two having UICC stage IV disease, were treated at the Peter MacCallum Cancer Institute between November 1995 and April 1998. Planned chemotherapy consisted initially of continuous infusion at 10 mg/m(2) per day of cisplatin and 400 mg/m(2) per day of fluorouracil on days 1-5 of weeks 6 and 7 of a conventionally fractionated course of radiotherapy. After the first 14 patients, the dose of fluorouracil was reduced to 360 mg/m(2) per day because of acute toxicity.36.8 months), with an estimated 50% surviving at 2 years (CI, 29-71%). Sixteen patients (57%) developed confluent mucositis and 11 (39%) developed patchy mucositis. The median duration of mucositis for these 27 patients was 1.5 months. Seventeen patients (61%) required nutritional support for a median duration of 1.4 months. Fourteen patients (50%) had grade three skin reactions, and 12 (43%) had one or more other significant (Grade 3) toxicities, predominantly infective. Grade 3 late toxicity has been observed in three patients to date (three xerostomia, including one with severe depression), and one patient had chronic ulceration of the oral tongue (grade 4). This chemoradiation regimen achieved an excellent complete response rate and good locoregional control at 2 years in patients with a poor initial prognosis. Acute toxicity was significant but manageable. The regimen offers an alternative to surgery and postoperative radiation therapy in locally advanced head and neck cancer.
本研究的目的是回顾我们对一种治疗方案的经验，该方案将常规分割放射治疗（7周内70 Gy）与化疗（顺铂和氟尿嘧啶）相结合，在放疗的最后2周同时给予先前未治疗的晚期头颈部鳞状细胞癌患者。1995年11月至1998年4月期间，28例患者在彼得·麦卡勒姆癌症研究所接受治疗，除2例患者外，其余均为国际抗癌联盟（UICC）IV期疾病。计划的化疗最初包括在常规分割放疗疗程的第6周和第7周的第1 - 5天，每天以10 mg/m²的剂量持续输注顺铂和每天400 mg/m²的剂量持续输注氟尿嘧啶。在前14例患者之后，由于急性毒性，氟尿嘧啶的剂量降至每天360 mg/m²。中位随访时间为36.8个月，估计2年生存率为50%（可信区间，29 - 71%）。16例患者（57%）发生融合性黏膜炎，11例患者（39%）发生斑片状黏膜炎。这27例患者黏膜炎的中位持续时间为1.5个月。17例患者（61%）需要营养支持，中位持续时间为1.4个月。14例患者（50%）出现3级皮肤反应，12例患者（43%）出现一种或多种其他严重（3级）毒性反应，主要为感染性。迄今为止，已在3例患者中观察到3级晚期毒性反应（3例口干，其中1例伴有严重抑郁），1例患者出现舌部慢性溃疡（4级）。这种放化疗方案在初始预后较差的患者中，2年时达到了优异的完全缓解率和良好的局部区域控制。急性毒性反应显著但可控制。该方案为局部晚期头颈部癌的手术和术后放疗提供了一种替代方案。
