Gedlicka C, Kornfehl J, Turhani D, Burian M, Formanek M
University of Vienna, Department of Otorhinolaryngology, Head and Neck Surgery, Vienna, Austria.
Cancer Invest. 2006 Apr-May;24(3):242-5. doi: 10.1080/07357900600633734.
The purpose of this retrospective evaluation was to assess the palliative effect of oral etoposide in heavily pretreated patients with squamous cell carcinoma of the head and neck.
Between October 1995 and February 2003, a total of 26 patients with metastatic and/or recurrent squamous cell carcinoma of the head and neck (SCCHN) were treated with oral etoposide. Therapy consisted of etoposide at a total dose of 100 mg daily for 7 days and was repeated every 4 weeks until progression of disease or for a maximum of 8 courses. Eighteen patients underwent primary surgery of the tumour followed by adjuvant irradiation or surgery after neoadjuvant radiochemotherapy. Eight patients had primary irradiation with or without concomitant chemotherapy. All patients previously received at least one palliative chemotherapy with cisplatin/5-floururacil (5-FU) or cisplatin/taxotere. Patients did not routinely receive anti-emetic medication.
All patients were eligible for toxicity and survival assessment, and 24 of 26 patients for response evaluation according to an intention-to-treat principle. Two patients had a partial response (8 percent); disease was stable in 9 patients (35 percent) and progressed in 13 patients (50 percent). The median time to progression for all patients was 3 months (range, 2-54), and median overall survival was 10 months (range, 2-52). Toxicity was in general mild and moderate (Grade 1 and 2), except three patients, who experienced Grade 3 anaemia, and one patient who had Grade 3 thrombocytopenia without bleeding complications. Severe nonhematologic adverse reactions were not seen, except for alopecia.
Our data suggest that oral etoposid is markedly effective, in regard to stabilization of disease and survival, and an excellent tolerated therapy for pretreated patients with recurrent and/or metastatic head and neck carcinomas. Its advantage over other commonly used and more intensive regimens such as 5-fluorouracil (5-FU) + cisplatin or taxane-containing combinations is its superior tolerance, in particular the incidence of nausea and vomiting, complete alopecia, and/or hematologic complications.
本回顾性评估旨在评估口服依托泊苷对经多程治疗的头颈部鳞状细胞癌患者的姑息治疗效果。
1995年10月至2003年2月期间，共有26例转移性和/或复发性头颈部鳞状细胞癌（SCCHN）患者接受了口服依托泊苷治疗。治疗方案为依托泊苷，每日总剂量100mg，连用7天，每4周重复一次，直至疾病进展或最多进行8个疗程。18例患者接受了肿瘤原发灶手术，随后进行辅助放疗或新辅助放化疗后手术。8例患者接受了单纯放疗或联合化疗。所有患者此前均至少接受过一次以顺铂/5-氟尿嘧啶（5-FU）或顺铂/多西他赛为主的姑息化疗。患者未常规接受止吐药物治疗。
所有患者均符合毒性和生存评估标准，26例患者中有24例根据意向性治疗原则进行疗效评估。2例患者部分缓解（8%）；疾病稳定9例（35%），进展13例（50%）。所有患者的中位疾病进展时间为3个月（范围2-54个月），中位总生存期为10个月（范围2-52个月）。毒性一般为轻至中度（1级和2级），3例患者出现3级贫血，1例患者出现3级血小板减少但无出血并发症。除脱发外，未见严重的非血液学不良反应。
我们的数据表明，口服依托泊苷在疾病稳定和生存方面具有显著疗效，对于复发和/或转移性头颈部癌的经治患者是一种耐受性良好的治疗方法。与其他常用的更强化的方案如5-氟尿嘧啶（5-FU）+顺铂或含紫杉烷的联合方案相比，其优势在于耐受性更好，尤其是恶心呕吐、完全脱发和/或血液学并发症的发生率更低。
