Bourhis J, Calais G, Lapeyre M, Tortochaux J, Alfonsi M, Sire C, Bardet E, Rives M, Bergerot P, Rhein B, Desprez B
Department of Radiation-Oncology, Gustave Roussy Institute, 39 rue Camille Desmoulins, 94805 Villejuif, France.
Semin Oncol. 2004 Dec;31(6):822-6. doi: 10.1053/j.seminoncol.2004.09.002.
In the early 1990s, when conventional radiotherapy (RT) was the standard of care in patients with locally advanced head and neck squamous cell carcinoma (HNSCC), two main options were being tested to improve the efficacy and the therapeutic ratio of RT. The first approach evaluated the effect of adding chemotherapy (CT) simultaneously to RT (RT-CT), while the second approach assessed the effect of modified fractionated RT. To answer these two questions, in 1994, the French Group for Head and Neck Oncology Radiotherapy (GORTEC) initiated two randomized trials. A total of 494 patients were entered in these two parallel phase III multicenter trials comparing conventional RT (70 Gy in 35 fractions) either with concomitant RT-CT (226 patients; 70 Gy in 35 fractions with three cycles of a 4-day regimen comprising carboplatin and 5-fluorouracil [5FU]) or with very accelerated RT (268 patients) delivering 64 Gy in 3 weeks. The 5-year overall survival (OS), specific disease-free survival (DFS), and local-regional control rates were improved in favor of simultaneous RT-CT, whereas local-regional control was significantly improved with accelerated RT, along with a marginal effect on OS and DFS. This increased antitumor efficacy was in both cases associated with a marked increase in acute RT-induced toxicity, which was more pronounced with accelerated RT, whereas late effects were marginally increased with the addition of CT and not influenced by accelerated RT. We conclude that both concomitant RT-CT and accelerated RT improved tumor control rates, as compared to conventional RT, along with increased but manageable toxicity. The two regimens are currently being tested in an ongoing randomized study and also being compared to moderately accelerated RT and concomitant CT.
20世纪90年代初，当传统放疗（RT）是局部晚期头颈部鳞状细胞癌（HNSCC）患者的标准治疗方法时，人们正在测试两种主要方法以提高放疗的疗效和治疗增益比。第一种方法评估同步添加化疗（CT）与放疗（RT-CT）的效果，而第二种方法评估改良分割放疗的效果。为了回答这两个问题，1994年，法国头颈肿瘤放疗组（GORTEC）启动了两项随机试验。共有494例患者进入这两项平行的III期多中心试验，比较传统放疗（35次分割照射70 Gy）与同步RT-CT（226例患者；35次分割照射70 Gy，同时进行三个周期的4天方案化疗，包括卡铂和5-氟尿嘧啶[5FU]）或超加速放疗（268例患者），后者在3周内给予64 Gy。同步RT-CT组的5年总生存率（OS）、特定无病生存率（DFS）和局部区域控制率有所提高，而超加速放疗显著提高了局部区域控制率，对OS和DFS有轻微影响。在这两种情况下，抗肿瘤疗效的提高都伴随着放疗急性毒性的显著增加，超加速放疗更为明显，而添加CT后晚期效应略有增加，不受超加速放疗影响。我们得出结论，与传统放疗相比，同步RT-CT和超加速放疗都提高了肿瘤控制率，同时毒性增加但可控。这两种方案目前正在一项正在进行的随机研究中进行测试，并且也与中度加速放疗和同步CT进行比较。
