Onat H, Basaran M, Esassolak M, Bavbek S E, Anacak Y, Kaytan E, Altun M, Haydaroglu A
Department of Medical Oncology, Institute of Oncology, University of Istanbul, Istanbul, Turkey.
Clin Oncol (R Coll Radiol). 2002 Dec;14(6):449-54. doi: 10.1053/clon.2002.0110.
Undifferentiated nasopharyngeal carcinoma (UNPC) is a chemosensitive tumour; a randomized study evaluating neoadjuvant chemotherapy with bleomycin/epidoxorubicin/cisplatin (BEC) in addition to conventional radiotherapy has resulted in a better disease-free survival in the chemotherapy arm. The bleomycin infusion in the BEC regimen has necessitated hospitalization for the infusion, and resulted in serious pulmonary toxicity. This study has aimed to omit the bleomycin, and test the efficacy and toxicity of cisplatin (C) and a higher dose of epidoxorubicin (EPI) in patients with locally advanced UNPC.
Seventy-one patients with locally advanced UNPC were treated with three cycles of C 100 mg/m2 day 1, and EPI 100 mg/m2 day 1 every 3 weeks followed by conventional radiotherapy of 70 Gy.
Neoadjuvant chemotherapy was well tolerated. There was only 1-week delay in 14.3% of the patients and no dose modification. Grade III-IV neutropenia occurred in 18.9% of the cycles: none of the patients developed neutropenic fever. No patient progressed during chemotherapy, the complete response rate was 26.8% (95% CI = 16.9-38.6) and the partial response rate was 59.1% (95% CI = 46.8-70.7) for an objective response rate of 85.9% (95% CI = 75.6-93.0) at the end of the three cycles of chemotherapy. After the completion of radiotherapy, the complete response rate increased to 81.7% (95% CI = 70.7-89.9) and the objective response increased to 91.5% (95% CI = 82.5-96.8). The median disease-free interval and the median survival have not been reached. The 5-year disease-free and overall survival rates are 53.0% (95% CI = 43.7-62.0) and 57.2% (95% CI = 48.3-65.2), respectively.
Neoadjuvant C and EPI, easily administered in the outpatient setting, is an effective and well-tolerated regimen in the treatment of locally advanced UNPC.
未分化鼻咽癌（UNPC）是一种对化疗敏感的肿瘤；一项随机研究评估了除传统放疗外，使用博来霉素/表柔比星/顺铂（BEC）进行新辅助化疗，结果显示化疗组的无病生存率更高。BEC方案中的博来霉素输注需要住院进行，且会导致严重的肺部毒性。本研究旨在省略博来霉素，并测试顺铂（C）和更高剂量表柔比星（EPI）对局部晚期UNPC患者的疗效和毒性。
71例局部晚期UNPC患者接受三个周期的治疗，第1天静脉滴注C 100mg/m²，每3周第1天静脉滴注EPI 100mg/m²，随后进行70Gy的传统放疗。
新辅助化疗耐受性良好。14.3%的患者仅延迟1周，且无需调整剂量。18.9%的周期出现III - IV级中性粒细胞减少：无患者发生中性粒细胞减少性发热。化疗期间无患者病情进展，三个周期化疗结束时，完全缓解率为26.8%（95%CI = 16.9 - 38.6），部分缓解率为59.1%（95%CI = 46.8 - 70.7），客观缓解率为85.9%（95%CI = 75.6 - 93.0）。放疗结束后，完全缓解率增至81.7%（95%CI = 70.7 - 89.9），客观缓解率增至91.5%（95%CI = 82.5 - 96.8）。无病间期和总生存期中位数尚未达到。5年无病生存率和总生存率分别为53.0%（95%CI = 43.7 - 62.0）和57.2%（95%CI = 48.3 - 65.2）。
新辅助C和EPI方案可在门诊轻松给药，是治疗局部晚期UNPC的一种有效且耐受性良好的方案。
