Hennemann B
Abteilung für Hämatologie und Onkoloie, Universitätsklinikum Regensburg.
Laryngorhinootologie. 2006 Mar;85(3):172-8. doi: 10.1055/s-2005-921107.
Patients with head and neck tumors are treated with palliative chemotherapy in case of the detection of distant metastases or local recurrence without the option of surgical therapy or radiation. Alongside 5-fluorouracil (5-FU) in combination with cisplatin or carboplatin, taxanes, gemcitabine and vinorelbine as well as monoclonal antibodies or small molecule tyrosine kinase inhibitors have been used.
This review analyses the published literature of the past 15 years, including selected abstracts with view to response rate, overall survival and adverse effects.
5-FU plus cisplatin or carboplatin can still be considered as standard treatment, achieving response rates of 20-30 %. The addition of taxanes increases the objective response rate but adds remarkable toxicity to the treatment protocol. Phase III studies demonstrate higher response rates but fail to demonstrate a significant increase of the overall survival after polychemotherapy as compared to monotherapy protocols. Thus, patients with a reduced performance can be treated with monotherapy. In case of disease progression after cisplatin-containing chemotherapy further treatment should only be offered to selected patients. For this situation, platin-free chemotherapy protocols containing taxanes, gemcitabine or vinorelbine seem promising. Recent studies with monoclonal antibodies or small molecule tyrosine kinase inhibitors report on a response rate of 10-20 %.
The use of new drugs increases the response rate and amends the side effects of the chemotherapy. However, phase III studies documenting an improved overall survival are lacking. Targeted therapies broaden the therapeutic armament, and possibly, EGFR inhibition will help to overcome chemotherapy resistance in the future.
对于头颈部肿瘤患者，若检测到远处转移或局部复发且无法进行手术治疗或放疗，则采用姑息化疗。除了5-氟尿嘧啶（5-FU）联合顺铂或卡铂外，紫杉烷类、吉西他滨、长春瑞滨以及单克隆抗体或小分子酪氨酸激酶抑制剂也已被使用。
本综述分析了过去15年发表的文献，包括部分摘要，涉及缓解率、总生存期和不良反应。
5-FU加顺铂或卡铂仍可被视为标准治疗，缓解率达20%-30%。添加紫杉烷类可提高客观缓解率，但会给治疗方案增加显著毒性。III期研究显示缓解率更高，但与单药治疗方案相比，多药化疗后总生存期未显著增加。因此，体能状态较差的患者可用单药治疗。含顺铂化疗后疾病进展的情况下，仅应选择部分患者进行进一步治疗。对于这种情况，不含铂的化疗方案，如含紫杉烷类、吉西他滨或长春瑞滨的方案似乎很有前景。近期关于单克隆抗体或小分子酪氨酸激酶抑制剂的研究报告缓解率为10%-20%。
新药的使用提高了缓解率并改善了化疗的副作用。然而，缺乏记录总生存期改善的III期研究。靶向治疗拓宽了治疗手段，未来表皮生长因子受体（EGFR）抑制可能有助于克服化疗耐药性。
