Itoi Aya, Takashima Masayuki, Ishimasa Hiroshi, Murata Hideyuki, Tomoda Koichi
Dept. of Otolaryngology, Head and Neck Surgery, Kanazawa Medical University.
Gan To Kagaku Ryoho. 2006 May;33(5):617-20.
Multimodality therapy incorporated with radiotherapy, surgery and chemotherapy are used in the treatment of head and neck cancer in order to improve the local control and survival rate. TS-1, a newly developed oral antitumor agent which could achieve the same therapeutic concentration as that of 5-FU under continuous and intravenous treatment, has been used as adjuvant therapy for carcinomas in recent years. We presented our experience applying a new regimen of TS-1 and its side effects. TS-1 has been applied for head and neck carcinomas since 2001. The oral application of TS-1 has been used in 32 cases of head and neck cancer in our department since 2003, and the agent has been applied in 22 of 32 cases as adjuvant therapy. The primary sites of malignancy included hypopharyngx (7 cases), larynx (6 cases), maxillary sinus (2 cases), oropharynx (2 cases), oral cavity (4 cases), submandibular gland (1 case) and one case in which the primary site was unknown. A regimen of four-week application followed by two-week rest had been used in 6 cases in the first part of this trial. However, a high frequency of blood toxicity was found from the third week, requiring alteration of the protocol. Thus, a new regimen of two-week application followed by one week rest was thereafter used in the other 16 cases. Blood toxicity was found in 66.7% of those cases receiving a four-week application followed by two-week rest regimen. In the 16 cases receiving the two-week application followed by one-week rest regimen, only one case showed grade 2 leucopenia while continuous application for more than eight weeks was possible in 9 cases. Mild macrocytic anemia was found in some of these cases, however none of which required any necessary interruption of the treatment. Side effects other than blood toxicity, such as edema or pigmentation of lower limbs, erythema of skin and diarrhea, were found in the other cases, requiring suspension of the treatment. But the subsequent application was possible after a break or decreasing the dosage. We concluded that the new regimen of two-week application followed by one-week rest is less likely to be interrupted by the side effects and is safer to be used outpatiently, compared with the four-week application followed by two-week rest.
多模态疗法结合放疗、手术和化疗用于治疗头颈癌，以提高局部控制率和生存率。替吉奥（TS-1）是一种新开发的口服抗肿瘤药物，在持续静脉给药时可达到与5-氟尿嘧啶相同的治疗浓度，近年来已被用作癌症的辅助治疗。我们介绍了应用替吉奥新方案的经验及其副作用。自2001年以来，替吉奥已应用于头颈癌。自2003年以来，我科对头颈癌患者口服替吉奥32例，其中22例作为辅助治疗。恶性肿瘤的原发部位包括下咽（7例）、喉（6例）、上颌窦（2例）、口咽（2例）、口腔（4例）、下颌下腺（1例），1例原发部位不明。本试验第一部分6例采用四周给药、两周休息的方案。然而，从第三周开始发现血液毒性发生率较高，需要改变方案。因此，此后另外16例采用两周给药、一周休息的新方案。接受四周给药、两周休息方案的患者中，66.7%出现血液毒性。在接受两周给药、一周休息方案的16例患者中，仅1例出现2级白细胞减少，9例患者可持续给药超过8周。部分患者出现轻度大细胞性贫血，但均无需中断治疗。其他患者出现血液毒性以外的副作用，如下肢水肿或色素沉着、皮肤红斑和腹泻，需要暂停治疗。但休息或减量后可继续用药。我们得出结论，与四周给药、两周休息的方案相比，两周给药、一周休息的新方案较少因副作用而中断，门诊使用更安全。
