Regine W F, Valentino J, Arnold S M, Haydon R C, Sloan D, Kenady D, Strottmann J, Pulmano C, Mohiuddin M
Department of Radiation Medicine, University of Kentucky, Lexington, KY 40536-0293, USA.
J Clin Oncol. 2001 Jul 15;19(14):3333-9. doi: 10.1200/JCO.2001.19.14.3333.
To evaluate the tolerance and efficacy of intra-arterial (IA) cisplatin boost with hyperfractionated radiation therapy (HFX-RT) in patients with advanced squamous cell carcinoma of the head and neck (SCCHN).
Forty-two patients with locally advanced primary SCCHN were treated on consecutive phase I/II studies of HFX-RT (receiving a total of 76.8 to 81.6 Gy, given at 1.2 Gy bid) and IA cisplatin (150 mg/m(2) received at the start of and during RT boost treatment).
Acute grade 3 to 4 toxicities were as follows: grade 4 and grade 3 mucosal toxicity occurred in three (7%) and 31 patients (69%), respectively, and grade 3 hematologic, infectious, and skin events occurred in one patient each. Eight of 24 patients (33%) were unable to receive a second planned dose of IA cisplatin because of general anxiety (n = 5), nausea and/or emesis (n = 2), or asymptomatic occlusion of an external carotid artery (n = 1). Thirty-seven patients (88%) experienced complete response (CR) at primary site. Twenty-nine (85%) of 34 patients presenting with nodal disease experienced CR. The actuarial 2-year rates of locoregional control and disease-specific and overall survival are 73%, 63%, and 57%, respectively, with a median active follow-up of 30 months.
In this highly unfavorable subset of patients, these results seem superior to previously reported chemoradiation regimens in more favorable patients. Use of a second dose of IA cisplatin boost was associated with increased toxicity without obvious therapeutic gain. This novel strategy allows for an incremental increase in the treatment intensity of the HFX-RT regimen recently established as superior to once-a-day RT.
评估动脉内（IA）顺铂增强联合超分割放射治疗（HFX-RT）对头颈部晚期鳞状细胞癌（SCCHN）患者的耐受性和疗效。
42例局部晚期原发性SCCHN患者接受了连续的I/II期HFX-RT研究（总剂量为76.8至81.6 Gy，每日两次，每次1.2 Gy）和IA顺铂治疗（在放疗增强治疗开始时及期间接受150 mg/m²）。
急性3至4级毒性反应如下：4级和3级黏膜毒性分别发生在3例（7%）和31例（69%）患者中，3级血液学、感染性和皮肤事件各发生在1例患者中。24例患者中有8例（33%）因全身焦虑（n = 5）、恶心和/或呕吐（n = 2）或颈外动脉无症状闭塞（n = 1）而无法接受第二次计划剂量的IA顺铂。37例患者（88%）原发部位出现完全缓解（CR）。34例有淋巴结疾病的患者中有29例（85%）出现CR。局部区域控制、疾病特异性生存率和总生存率的2年精算率分别为73%、63%和57%，中位积极随访时间为30个月。
在这一预后极差的患者亚组中，这些结果似乎优于先前报道的针对预后较好患者的放化疗方案。使用第二剂IA顺铂增强与毒性增加相关，且无明显治疗获益。这种新策略使得HFX-RT方案的治疗强度得以逐步提高，该方案最近已被确立优于每日一次放疗。
