Hoebers Frank J P, Heemsbergen Wilma, Balm Alfons J M, van Zanten Mathilde, Schornagel Jan H, Rasch Coen R N
Department of Radiotherapy, The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
Radiother Oncol. 2007 Oct;85(1):42-7. doi: 10.1016/j.radonc.2007.03.014. Epub 2007 Apr 18.
To evaluate treatment results of concurrent chemoradiation with daily low dose cisplatin.
121 patients with advanced stage HNSCC were treated with RT (35 x 2 Gy) and cisplatin (6 mg/m(2) i.v. x20, daily before RT). After 47 patients, the treatment protocol (Standard Group) was changed: Daily i.v. prehydration and accelerated RT were given to the subsequent 74 patients (Hydr-Ac-RT Group).
Mean follow-up was 29 months (range 7-62). More chemotherapy could be administered in the Hydr-Ac-RT Group (maximum no. of 20 cisplatin-infusions increased from 59% to 91% of patients, p=0.008), with less renal toxicity (p<0.001) and less hospital admissions (p<0.02). However, mucositis was more pronounced and tubefeeding more frequent in the Hydr-Ac-RT Group. The CR rate of the primary tumor increased from 74% (Standard Group) to 90% (Hydr-Ac-RT Group) (p=0.06), although this did not lead to an improvement in loco-regional control.
Concurrent chemoradiation with daily low dose cisplatin is feasible and effective for selected patients with advanced HNSCC. Although the addition of accelerated RT resulted in more mucositis and tubefeeding, the introduction of prehydration led to better compliance to therapy with more chemotherapy administered and less hospital admissions.
评估每日低剂量顺铂同步放化疗的治疗效果。
121例晚期头颈部鳞状细胞癌患者接受放疗（35次，每次2Gy）和顺铂治疗（静脉注射6mg/m²，共20次，放疗前每日一次）。47例患者之后，治疗方案发生改变：随后的74例患者接受每日静脉预水化及加速放疗（水化-加速放疗组）。
平均随访29个月（范围7 - 62个月）。水化-加速放疗组能够给予更多的化疗（顺铂最大输注次数从患者的59%增加到91%，p = 0.008），肾毒性更小（p < 0.001），住院次数更少（p < 0.02）。然而，水化-加速放疗组的黏膜炎更明显，鼻饲更频繁。原发肿瘤的完全缓解率从74%（标准组）提高到90%（水化-加速放疗组）（p = 0.06），尽管这并未导致局部区域控制的改善。
对于部分晚期头颈部鳞状细胞癌患者，每日低剂量顺铂同步放化疗是可行且有效的。虽然加速放疗会导致更多的黏膜炎和鼻饲，但预水化的引入使得治疗依从性更好，化疗给药更多，住院次数更少。
