Dobrowsky W, Naudé J
Department of Radiotherapy and Radiobiology, University of Vienna, Allgemeines Krankenhaus der Stadt Wien, Waehringer Guertel 18-20, A-1090 Vienna, Austria.
Radiother Oncol. 2000 Nov;57(2):119-24. doi: 10.1016/s0167-8140(00)00233-4.
Radiation therapy is often the primary treatment for advanced cases of head and neck cancers not considered suitable for radical surgery. In these cases locoregional tumour control rates are low and has warranted innovative treatment modifications, such as altered fractionation schedules and combination with chemotherapy.
From October 1990 to December 1997, 239 patients with squamous cell cancers originating in the head and neck region were randomized to one of three treatment options. Standard therapy consisting of conventional fractionation with 70 Gy in 7 weeks in 35 fractions (CF). The second treatment option consisted of a continuous hyperfractionated accelerated radiotherapy delivering a total dose of 55.3 Gy in 33 fractions over 17 consecutive days (V-CHART). The third study arm had identical fractionation and dose as the above accelerated treatment, with the additional administration of 20 mg/m(2) mitomycin C (MMC) on day 5 of treatment (V-CHART+MMC).
Main toxicity resulted from accelerated fractionation in confluent mucositis (Grade 3-4 in 95%) requiring nasogastral tube feeding, analgetics and antiphlogistics in the majority of cases. Haematological toxicity Grade 3-4 was seen after MMC administration in 18%. MMC administration did not influence mucosal reaction. Overall duration of mucositis was not different in the three treatment groups. Loco-regional tumour control was 31% after CF, 32% after V-CHART and 48% after V-CHART+MMC, respectively (P<0.05). Overall crude survival was 24% after CF, 31% following V-CHART and 41% after V-CHART+MMC, respectively (P<0.05). Median follow up was 48 months (assessment performed in February 1999).
Following shortening overall treatment time from 7 weeks to 17 consecutive days and dose of radiotherapy from 70 to 55.3 Gy the results in the radiotherapy only treated patients are identical. A significant improvement regarding local tumour control and survival was seen following administration of MMC to the accelerated fractionated treatment.
放射治疗通常是不适合根治性手术的晚期头颈癌的主要治疗方法。在这些病例中，局部区域肿瘤控制率较低，因此有必要进行创新性的治疗调整，如改变分割方案以及与化疗联合使用。
从1990年10月至1997年12月，239例起源于头颈区域的鳞状细胞癌患者被随机分为三种治疗方案之一。标准治疗包括在7周内分35次给予70 Gy的常规分割（CF）。第二种治疗方案包括连续超分割加速放疗，在连续17天内分33次给予总剂量55.3 Gy（V-CHART）。第三个研究组的分割和剂量与上述加速治疗相同，在治疗第5天额外给予20 mg/m²丝裂霉素C（MMC）（V-CHART+MMC）。
主要毒性源于加速分割导致的融合性黏膜炎（95%为3-4级），大多数病例需要鼻胃管喂养、镇痛药和消炎药。18%的患者在给予MMC后出现3-4级血液学毒性。MMC的使用不影响黏膜反应。三个治疗组黏膜炎的总体持续时间无差异。CF组、V-CHART组和V-CHART+MMC组的局部区域肿瘤控制率分别为31%、32%和48%（P<0.05）。CF组、V-CHART组和V-CHART+MMC组的总体粗生存率分别为24%、31%和41%（P<0.05）。中位随访时间为48个月（1999年2月进行评估）。
将总体治疗时间从7周缩短至连续17天，放疗剂量从70 Gy降至55.3 Gy后，单纯放疗患者的结果相同。在加速分割治疗中给予MMC后，局部肿瘤控制和生存率有显著改善。
