Marcu Loredana, van Doorn Tim, Olver Ian
Department of Physics and Mathematical Physics, University of Adelaide, Royal Adelaide Hospital, Australia.
Acta Oncol. 2003;42(4):315-25. doi: 10.1080/02841860310004364.
A review of the published literature has been undertaken to ascertain the trends in treatment schedules of unresectable head and neck cancer (HNC) using cisplatin in conjunction with radiotherapy. In addition, four trials were reviewed where cisplatin was examined as a single agent without radiotherapy, demonstrating that cisplatin alone has a palliative effect only, and for a curative intent should be used in combination with radiation. Of the numerous clinical trials published on such combined chemo-radiotherapy, 16 were selected for analysis fulfilling the following criteria: cisplatin used as the sole chemotherapeutic agent in combination with radiation for patients with unresectable squamous cell carcinomas of the head and neck, with no previous treatment for the same malignancy. Daily low-dose cisplatin performed in 6 out of the 16 trials demonstrated increased tumour control with less toxicity as compared to weekly high-dose drug delivery. The increased tumour control with a daily low-dose schedule reflects the observation that cisplatin dissociates from the DNA in 24 h. Other cisplatin properties (e.g. radiosensitizing) also have the potential to influence chemo-radiotherapy treatment outcomes. There is significant scope to further optimize the treatment schedule for the unresectable HNC through detailed study of the pharmacokinetics and radiobiology of combined chemo-radiotherapy.
我们对已发表的文献进行了综述，以确定使用顺铂联合放疗治疗不可切除头颈部癌（HNC）的治疗方案趋势。此外，我们还回顾了四项试验，其中顺铂作为单一药物在无放疗情况下进行研究，结果表明顺铂单独使用仅具有姑息作用，若要有治愈意图则应与放疗联合使用。在众多发表的关于这种联合放化疗的临床试验中，选择了16项符合以下标准的试验进行分析：顺铂作为唯一化疗药物与放疗联合用于不可切除的头颈部鳞状细胞癌患者，且之前未针对同一恶性肿瘤进行过治疗。16项试验中有6项采用每日低剂量顺铂，与每周高剂量给药相比，显示出肿瘤控制率提高且毒性更小。每日低剂量方案肿瘤控制率的提高反映了顺铂在24小时内从DNA解离的观察结果。顺铂的其他特性（如放射增敏）也有可能影响放化疗治疗结果。通过对联合放化疗的药代动力学和放射生物学进行详细研究，有很大空间进一步优化不可切除HNC的治疗方案。
