Tishler Roy B, Posner Marshall R, Norris Charles M, Mahadevan Anand, Sullivan Christopher, Goguen Laura, Wirth Lori J, Costello Rosemary, Case MaryAnn, Stowell Sara, Sammartino Dan, Busse Paul M, Haddad Robert I
Department of Radiation Oncology, Dana Farber Cancer Institute, Brigham and Women's Hospital, Boston, MA 02115, USA.
Int J Radiat Oncol Biol Phys. 2006 Jul 15;65(4):1036-44. doi: 10.1016/j.ijrobp.2006.02.010. Epub 2006 May 6.
In a Phase I/II trial, we investigated concurrent weekly docetaxel and concomitant boost radiation in patients with locally advanced squamous cell cancer of the head and neck (SCCHN) after induction chemotherapy.
Patients presented with American Joint Committee on Cancer Stage III/IV and were treated initially with induction chemotherapy using cisplatinum/5-fluorouracil (PF), carboplatinum-5-FU, or docetaxel-PF. Patients then received docetaxel four times weekly with concomitant boost (CB) radiation (1.8 Gy once-daily X20, 1.8/1.5 Gy twice a day). Fifteen patients each received 20 mg/M2 and 25 mg/M2.
Thirty-one patients were enrolled and 30 were evaluable for response and toxicity. Median follow-up was 42 months (range, 27-63 months). Primary sites were: oropharynx 19, oral cavity 2, larynx/hypopharynx 5, and unknown primary 4. Eighty-seven percent of patients had N2/N3 disease; 60% had T3/T4 disease. Twenty percent of patients had a complete response (CR) to induction chemotherapy. After chemoradiotherapy, 21 of 30 patients had a CR, 2 had progressive disease, and 7 had partial response (PR). Nineteen of 26 patients presenting with neck disease had neck dissections, and 7 of 19 were positive. Ninety-three percent of all patients were rendered disease-free after all planned therapy. Treatment failed in 8 patients, and 7 have died of disease. An additional patient died with no evidence of disease. Twenty-one patients (70%) are currently alive with no evidence of disease. No acute dose-limiting toxicity was observed at either dose level.
This intensive treatment regimen of concurrent docetaxel/concomitant boost radiation and surgery after induction chemotherapy in poor prognosis patients yields good local regional control and survival. Docetaxel/CB chemoradiotherapy represents an aggressive alternative regimen to platinum-based chemoradiotherapy or surgery in patients who have a poor response to induction chemotherapy.
在一项I/II期试验中，我们研究了诱导化疗后局部晚期头颈部鳞状细胞癌（SCCHN）患者每周同步使用多西他赛和同步推量放疗的情况。
患者为美国癌症联合委员会III/IV期，最初接受顺铂/5-氟尿嘧啶（PF）、卡铂-5-氟尿嘧啶或多西他赛-PF诱导化疗。然后患者每周接受4次多西他赛治疗，并同步推量（CB）放疗（每日1次，每次1.8 Gy，共20次；或每日2次，每次1.8/1.5 Gy）。15名患者分别接受20 mg/M2和25 mg/M2剂量。
31名患者入组，30名患者可评估疗效和毒性。中位随访时间为42个月（范围27 - 63个月）。原发部位为：口咽19例、口腔2例、喉/下咽5例、原发灶不明4例。87%的患者有N2/N3期疾病；60%的患者有T3/T4期疾病。20%的患者对诱导化疗有完全缓解（CR）。放化疗后，30例患者中有21例达到CR，2例病情进展，7例部分缓解（PR）。26例有颈部疾病的患者中有19例行颈部清扫术，其中19例中有7例阳性。所有计划治疗后，93%的患者疾病缓解。8例患者治疗失败，7例死于疾病。另有1例患者死亡，但无疾病证据。21例患者（70%）目前存活且无疾病证据。两个剂量水平均未观察到急性剂量限制性毒性。
对于预后不良的患者，这种在诱导化疗后同步使用多西他赛/同步推量放疗和手术的强化治疗方案可产生良好的局部区域控制和生存率。多西他赛/CB放化疗是诱导化疗反应不佳患者中铂类放化疗或手术的一种积极替代方案。
