Nagar Yoodhvir Singh, Singh Shalini, Datta Niloy Ranjan
Department of Radiotherapy, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
Jpn J Clin Oncol. 2004 Feb;34(2):61-8. doi: 10.1093/jjco/hyh017.
This retrospective study was carried out to evaluate the feasibility and safety of chemo-reirradiation as a salvage treatment in patients with persistent/recurrent head and neck cancers.
From 1991 to 1999, records of 131 patients with head and neck carcinoma who had loco-regional persistent/recurrent disease following curative therapy were analyzed. Of these, 33 patients had received chemo-reirradiation. Four patients were further excluded as they had been reirradiated by brachytherapy or external radiotherapy alone. The remaining 29 patients received reirradiation along with chemotherapy. They were evaluated for toxicity profile, post-salvage survival and overall survival.
The median reirradiation dose was 34 Gy (range, 12-50 Gy) and median cumulative RT dose was 104 Gy (range, 72-124 Gy). The median for chemotherapy cycles was four. Grade 2/3 mucositis, dermatitis, neutropenia were seen in 10%, 7% and 3% of patients, respectively. An overall response rate was seen in 83% of patients with complete response in 31%. All complete responders had received a cumulative RT dose of >/=100 Gy. Those patients who were initially treated by external radiation alone benefited with subsequent chemo-reirradiation with a complete response rate of 54%. The median post-salvage overall survival was 9 months with the 1- and 2-year survival rates being 41% and 12%, respectively. The post-salvage disease free survival (P = 0.01) and overall survival (P = 0.008) were also significantly better in patients who were treated initially by external radiotherapy alone.
Chemo-reirradiation appears feasible and effective in patients treated previously with external radiotherapy but needs proper patient selection. Patients should be given optimum reirradiation dose, with cumulative doses of >/=100 Gy, along with chemotherapy. This study warrants the need for more prospective trials.
本回顾性研究旨在评估化学再程放疗作为持续性/复发性头颈癌挽救性治疗的可行性和安全性。
分析1991年至1999年期间131例头颈部癌患者的记录，这些患者在根治性治疗后出现局部区域持续性/复发性疾病。其中，33例患者接受了化学再程放疗。4例患者因仅接受近距离放疗或外照射放疗而再程放疗，被进一步排除。其余29例患者接受了再程放疗联合化疗。对他们进行毒性特征、挽救治疗后生存率和总生存率评估。
再程放疗的中位剂量为34 Gy（范围12 - 50 Gy），中位累积放疗剂量为104 Gy（范围72 - 124 Gy）。化疗周期的中位数为4个。2/3级黏膜炎、皮炎、中性粒细胞减少分别见于10%、7%和3%的患者。83%的患者出现总体缓解率，31%的患者完全缓解。所有完全缓解者接受的累积放疗剂量≥100 Gy。那些最初仅接受外照射放疗的患者在随后的化学再程放疗中获益，完全缓解率为54%。挽救治疗后的中位总生存期为9个月，1年和2年生存率分别为41%和12%。最初仅接受外照射放疗的患者，挽救治疗后的无病生存期（P = 0.01）和总生存期（P = 0.008）也显著更好。
化学再程放疗在先前接受外照射放疗的患者中似乎可行且有效，但需要适当选择患者。应给予患者最佳的再程放疗剂量，累积剂量≥100 Gy，并联合化疗。本研究表明需要更多的前瞻性试验。
