Bachouchi M, Cvitkovic E, Azli N, Gasmi J, Cortes-Funes H, Boussen H, Rahal M, Kalifa C, Schwaab G, Eschwege F
Department of Medicine, Institut Gustave Roussy, Villejuif, France.
J Natl Cancer Inst. 1990 Apr 4;82(7):616-20. doi: 10.1093/jnci/82.7.616.
Undifferentiated carcinoma of nasopharyngeal type (UCNT) is a geographically endemic, Epstein-Barr virus-related carcinoma of epidermoid origin with reported 5-year survival rates of 15%-40% when treated with radiotherapy alone. Although UCNT can be well controlled locally by radiation therapy, in advanced nodal stage N3 [International Union Against Cancer-American Joint Committee on Cancer (UICC-AJCC, 1987)] the survival rate is below 20%, primarily because of metastatic spread in 80% of the fatalities. We report a pilot study of 41 patients with nonmetastatic, locoregionally advanced disease (85% of the patients had a nodal status greater than or equal to N2C-N3; 43% had T4 primaries), during which we used a combination of 100 mg of cisplatin/m2 on day 1, 15 mg of bleomycin by intravenous push and 12 mg/m2 by continuous infusion on days 1-5, and 70 mg of epirubicin/m2 on day 1 every 21 days for three cycles before definitive radiation therapy with 70 Gy for 7 weeks. Twenty-seven of 41 patients (66%; 95% confidence interval = 52.5%-80.5%) achieved a clinical complete response, and 40 of 41 (98%) had a major objective response after chemotherapy. Two deaths were treatment related, but side effects were moderate, and the overall treatment sequence was feasible. At the end of radiation therapy, all 39 assessable patients were in complete response, with a median follow-up of 21+ months (greater than 10-greater than 31); 33 (80%) patients had no evidence of disease. We believe that such a complete response rate in a high-volume disease with the use of combined modality treatment indicates a therapeutic gain in UCNT. Researchers performing a multicenter international controlled trial will test this hypothesis and compare local control, disease-free, and overall survival of the therapeutic sequence presented here with radiotherapy alone.
鼻咽型未分化癌（UCNT）是一种具有地域流行性、与爱泼斯坦-巴尔病毒相关的表皮样起源癌，据报道单独采用放射治疗时5年生存率为15% - 40%。尽管UCNT可通过放射治疗在局部得到良好控制，但在晚期淋巴结分期N3[国际抗癌联盟 - 美国癌症联合委员会（UICC - AJCC，1987）]时，生存率低于20%，主要原因是80%的死亡病例存在转移扩散。我们报告了一项针对41例非转移性、局部区域晚期疾病患者的初步研究（85%的患者淋巴结状态大于或等于N2C - N3；43%的患者原发灶为T4），在此期间，我们在第1天使用100 mg/m²顺铂，第1 - 5天静脉推注15 mg博来霉素并持续输注12 mg/m²，每21天在第1天使用70 mg/m²表柔比星，共三个周期，然后进行为期7周、总剂量70 Gy的确定性放射治疗。41例患者中有27例（66%；95%置信区间 = 52.5% - 80.5%）达到临床完全缓解，41例中有40例（98%）在化疗后有主要客观缓解。有2例死亡与治疗相关，但副作用为中度，总体治疗方案可行。在放射治疗结束时，所有39例可评估患者均完全缓解，中位随访时间为21 + 个月（大于10 - 大于31）；33例（80%）患者无疾病证据。我们认为，在这种高负荷疾病中采用综合治疗方式能达到如此高的完全缓解率表明UCNT治疗取得了疗效提升。进行多中心国际对照试验的研究人员将检验这一假设，并比较此处提出的治疗方案与单纯放射治疗的局部控制、无病生存率和总生存率。
