Mantz C A, Vokes E E, Stenson K, Kies M S, Mittal B, Witt M E, List M A, Weichselbaum R R, Haraf D J
Department of Cellular and Radiation Oncology, University of Chicago, Illinois 60637, USA.
Cancer J. 2001 Mar-Apr;7(2):140-8.
Locoregionally advanced oropharyngeal cancer has been conventionally treated with either surgery and adjuvant radiotherapy or radiotherapy alone, and clinical and functional outcomes have been poor. Chemoradiotherapy has been demonstrated to improve functional outcome and disease control over conventional treatment in recent randomized head and neck trials. Herein, we report overall survival, progression-free survival, and patterns of failure in locoregionally advanced oropharyngeal cancer treated with induction chemotherapy with or without conservative surgery followed by concomitant chemoradiation.
Three cycles of induction chemotherapy consisting of cisplatin, 5-fluorouracil, leucovorin, and interferon alpha-2b (PFL-IFN) were followed by conservative, organ-sparing surgery for residual disease. All patients then proceeded to concomitant chemoradiation consisting of seven or eight cycles of 5-fluorouracil, hydroxyurea, and a total radiotherapy dose of roughly 7,000 cGy.
Sixty-one patients with predominantly stage IV disease were treated. Clinical complete response was observed in 65% of patients after induction therapy. The median follow-up was 68.0 months for survivors and 39.0 months for all patients. At 5 years, overall survival is 51%, progression-free survival is 64%, locoregional control is 70%, and distant control is 89%. Locoregional recurrence accounted for 80% of all initial failures. Only five radical surgeries (none were total glossectomy) were performed for initial disease control. Treatment-related toxicity accounted for four deaths.
PFL-IFN given with 5-fluorouracil, hydroxyurea, and radiotherapy produces a high rate of cures with organ preservation in a disease group that has traditionally fared poorly. Local and distant disease control and survival rates exceed those observed with more standard treatment approaches involving surgery and radiotherapy. Further investigation into chemoradiotherapy as a curative modality for this disease is warranted.
局部区域晚期口咽癌传统上采用手术加辅助放疗或单纯放疗，临床和功能结局较差。在近期的随机头颈试验中，放化疗已被证明在功能结局和疾病控制方面优于传统治疗。在此，我们报告了接受诱导化疗（有或无保守手术）后序贯同步放化疗的局部区域晚期口咽癌的总生存、无进展生存及失败模式。
三个周期的诱导化疗，方案为顺铂、5-氟尿嘧啶、亚叶酸钙和α-2b干扰素（PFL-IFN），之后对残留病灶行保守性保器官手术。所有患者随后接受同步放化疗，方案为七或八个周期的5-氟尿嘧啶、羟基脲，总放疗剂量约7000cGy。
61例主要为IV期疾病的患者接受了治疗。诱导治疗后65%的患者观察到临床完全缓解。幸存者的中位随访时间为68.0个月，所有患者的中位随访时间为39.0个月。5年时，总生存率为51%，无进展生存率为64%，局部区域控制率为70%，远处控制率为89%。局部区域复发占所有初始失败的80%。仅进行了5例根治性手术（均非全舌切除术）用于初始疾病控制。治疗相关毒性导致4例死亡。
PFL-IFN联合5-氟尿嘧啶、羟基脲和放疗在传统预后较差的疾病组中可实现高治愈率并保留器官。局部和远处疾病控制率及生存率超过了采用手术和放疗等更标准治疗方法时观察到的结果。有必要进一步研究放化疗作为该疾病的治愈性治疗方式。
