Maguire P D, Meyerson M B, Neal C R, Hamann M S, Bost A L, Anagnost J W, Ungaro P C, Pollock H D, McMurray J E, Wilson E P, Kotwall C A
Department of Radiology, New Hanover Regional Medical Center, Wilmington, NC, USA.
Int J Radiat Oncol Biol Phys. 2004 Mar 1;58(3):698-704. doi: 10.1016/S0360-3016(03)01576-1.
To evaluate efficacy and toxicity of the Duke University chemoirradiation regimen for locally advanced head-and-neck cancer in a regional community cancer center.
Between June 1998 and June 2002, 50 patients with Stage III or IVA squamous cell carcinoma of the head and neck were treated definitively with concurrent combined modality therapy (CMT). Patients received accelerated, hyperfractionated radiotherapy (AFRT), 1.2-1.25 Gy b.i.d., to a median prescribed dose of 70 Gy. Chemotherapy consisted of cisplatin 12 mg and fluorouracil 600 mg/m(2) daily for 5 consecutive days during Weeks 1 and 6, followed by two cycles after AFRT. Patients with N2-N3 neck disease (n = 21; 42%) were considered for neck dissection depending on their response to AFRT and chemotherapy. Twenty-nine patients with Stage III and IVA disease treated between 1991 and 1997 with definitive RT alone served as historical controls.
Forty-nine patients (98%) in the CMT group completed the prescribed AFRT and 38 (76%) completed four cycles of chemotherapy. Three of 8 patients who underwent neck dissection had a pathologically complete response. The median follow-up for all patients was 23 months. The actuarial progression-free survival rate at 2 years was 75% for the CMT group vs. 40% (p <0.01) for the RT group. The overall survival rate was 80% and 43% (p <0.01), respectively, for the CMT and RT groups. Acute Radiation Therapy Oncology Group Grade 3 toxicities for the CMT group were mucosal (n = 50; 100%), skin (n = 9; 18%), and hematologic (n = 3; 6%). Late Grade 3-4 toxicities consisted of pharyngeal stricture (n = 7; 14%), laryngeal chondritis (n = 3; 6%), osteoradionecrosis (n = 2; 4%), and peripheral neuropathy (n = 1; 2%).
This aggressive regimen of AFRT with concurrent cisplatin and fluorouracil with or without neck dissection is feasible in the community setting for patients with Stage III and IVA head-and-neck cancer. Early results indicated excellent survival, albeit with universal acute mucosal, and considerable, although acceptable, late toxicity.
在一个地区性社区癌症中心评估杜克大学放化疗方案治疗局部晚期头颈癌的疗效和毒性。
1998年6月至2002年6月期间，50例Ⅲ期或ⅣA期头颈鳞状细胞癌患者接受了同步综合治疗（CMT）。患者接受加速超分割放疗（AFRT），每日两次，每次1.2 - 1.25 Gy，中位处方剂量为70 Gy。化疗方案为顺铂12 mg和氟尿嘧啶600 mg/m²，在第1周和第6周连续5天每日给药，AFRT后再进行两个周期。有N2 - N3颈部疾病的患者（n = 21；42%）根据其对AFRT和化疗的反应考虑是否行颈部清扫术。29例在1991年至1997年期间仅接受根治性放疗的Ⅲ期和ⅣA期疾病患者作为历史对照。
CMT组49例患者（98%）完成了规定的AFRT，38例（76%）完成了四个周期的化疗。8例行颈部清扫术的患者中有3例病理完全缓解。所有患者的中位随访时间为23个月。CMT组2年的无进展生存率为75%，而放疗组为40%（p <0.01）。CMT组和放疗组的总生存率分别为80%和43%（p <0.01）。CMT组急性放射治疗肿瘤学组3级毒性反应包括黏膜毒性（n = 50；100%）、皮肤毒性（n = 9；18%）和血液学毒性（n = 3；6%）。晚期3 - 4级毒性反应包括咽狭窄（n = 7；14%）、喉软骨炎（n = 3；6%）、骨放射性坏死（n = 2；4%）和周围神经病变（n = 1；2%）。
对于Ⅲ期和ⅣA期头颈癌患者，这种AFRT联合顺铂和氟尿嘧啶并联合或不联合颈部清扫术的积极方案在社区环境中是可行的。早期结果显示生存率优异，尽管普遍存在急性黏膜毒性，且存在相当程度但可接受的晚期毒性。
