Rabbani Anna, Hinerman Russell W, Schmalfuss Ilona M, Amdur Robert J, Morris Christopher G, Peters Keith R, Robbins K Thomas, Mendenhall William M
Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL, USA.
Am J Clin Oncol. 2007 Jun;30(3):283-6. doi: 10.1097/01.coc.0000258118.38177.74.
Review of the University of Florida experience in treating advanced squamous cell carcinomas of the head and neck with concurrent intraarterial cisplatin and radiotherapy (RADPLAT).
Thirty-five patients with Stage III or IV head and neck squamous cell carcinomas were treated between November 2000 and October 2001 with 3 to 4 cycles of weekly intraarterial cisplatin (150 mg/m2) and a rapid infusion of the neutralizing agent sodium thiosulfate (9 g/m2), followed by a continuous infusion of sodium thiosulfate (12 g/m2), with concomitant radiotherapy (RT). The primary site was treated with 70 Gy in 35 fractions with 6 MV photons, and the low neck received 50 to 70 Gy depending on nodal involvement. Median follow-up for all patients was 4.06 years; median follow-up for living patients was 4.34 years.
The 4-year outcomes were: local-regional control, 78%; distant metastasis-free survival, 83%; cause-specific survival, 65%; and survival, 57%. The majority of patients with recurrent disease failed at the primary site (73%); the remaining 27% of patients with recurrent disease failed only in distant sites. Nine patients required a neck dissection after chemoradiation because of suspected residual disease; 2 of 9 patients had residual tumor in the neck nodes. Severe osteoradionecrosis occurred in 26% of patients, and 9 of 35 patients (26%) required a permanent gastrostomy.
RADPLAT results in excellent local-regional control and survival in patients with advanced squamous cell carcinomas of the head and neck. Outcomes from the University of Florida are comparable to those reported by other institutions. However, in our limited experience, the likelihood of osteoradionecrosis and permanent gastrostomy may be higher than what might be anticipated after RT alone or combined with intravenous chemotherapy.
回顾佛罗里达大学采用动脉内顺铂与放疗同步进行（RADPLAT）治疗晚期头颈部鳞状细胞癌的经验。
2000年11月至2001年10月期间，35例Ⅲ期或Ⅳ期头颈部鳞状细胞癌患者接受了3至4个周期的每周动脉内顺铂治疗（150mg/m²），并快速输注中和剂硫代硫酸钠（9g/m²），随后持续输注硫代硫酸钠（12g/m²），同时进行放疗（RT）。原发部位采用6MV光子以35次分割给予70Gy照射，低颈部根据淋巴结受累情况接受50至70Gy照射。所有患者的中位随访时间为4.06年；存活患者的中位随访时间为4.34年。
4年的结果为：局部区域控制率为78%；无远处转移生存率为83%；病因特异性生存率为65%；总生存率为57%。大多数复发患者在原发部位出现失败（73%）；其余27%的复发患者仅在远处部位出现失败。9例患者因怀疑有残留病灶在放化疗后需要进行颈部清扫；9例患者中有2例颈部淋巴结有残留肿瘤。26%的患者发生了严重的放射性骨坏死，35例患者中有9例（26%）需要进行永久性胃造口术。
RADPLAT对头颈部晚期鳞状细胞癌患者可产生优异的局部区域控制率和生存率。佛罗里达大学的结果与其他机构报告的结果相当。然而，根据我们有限的经验，放射性骨坏死和永久性胃造口术的发生率可能高于单纯放疗或联合静脉化疗后的预期发生率。
