Salama J K, Stenson K M, Kistner E O, Mittal B B, Argiris A, Witt M E, Rosen F, Brockstein B E, Cohen E E W, Haraf D J, Vokes E E
Department of Radiation and Cellular Oncology, University of Chicago, Chicago, IL 60637, USA.
Ann Oncol. 2008 Oct;19(10):1787-94. doi: 10.1093/annonc/mdn364. Epub 2008 Jun 6.
We hypothesized induction chemotherapy (IndCT) would improve distant control (DC) without compromising locoregional control (LRC) for locoregionally advanced head and neck cancer patients. Additionally, we systematically lowered radiotherapy (RT) doses attempting to maintain LRC while decreasing toxicity.
Stages III-IV (M0) locoregionally advanced head and neck cancer patients received carboplatin/paclitaxel (Taxol) IndCT followed by four or five cycles consisting of 5 days of paclitaxel, fluorouracil, hydroxyurea, and BID RT followed by a nine day break. RT dose to gross disease (high risk), intermediate, and low-risk volumes were reduced from cohort A (n = 68): 75, 60, and 45 Gy; to cohort B (n = 64): 75, 54, and 39 Gy; then cohort C (n = 90): 72, 51, and 36 Gy.
A total of 222 patients accrued from November 1998 to September 2002. Median follow-up is 56 months. In all, 93/96/76% achieved a complete response to concurrent chemoradiotherapy (CRT) in cohort A/B/C. Three- and 5-year overall survivals (OSs) are 68% and 62%, respectively. Five-year LRC and DC are 91% and 87%, respectively. Response to IndCT predicted for OS, LRC, and time to progression (TTP). Cohort C patients had similar OS (P = 0.95), LRC, and DC, but worse (TTP) (P = 0.027).
IndCT before CRT reduces distant progression while maintaining high LRC. The cohort B schedule provides the best therapeutic ratio. A randomized trial investigating IndCT before CRT has been initiated.
我们假设诱导化疗（IndCT）可改善局部晚期头颈癌患者的远处控制（DC），且不影响局部区域控制（LRC）。此外，我们系统性地降低了放疗（RT）剂量，试图在降低毒性的同时维持LRC。
III-IV期（M0）局部晚期头颈癌患者接受卡铂/紫杉醇（泰素）诱导化疗，随后进行4或5个周期治疗，每个周期包括5天的紫杉醇、氟尿嘧啶、羟基脲治疗以及每日两次放疗，之后休息9天。对大体肿瘤（高风险）、中等风险和低风险体积的放疗剂量从A组（n = 68）的75、60和45 Gy，降至B组（n = 64）的75、54和39 Gy，再降至C组（n = 90）的72、51和36 Gy。
1998年11月至2002年9月共纳入222例患者。中位随访时间为56个月。A/B/C组分别有93%/96%/76%的患者在同步放化疗（CRT）后达到完全缓解。3年和5年总生存率（OS）分别为68%和62%。5年LRC和DC分别为91%和87%。诱导化疗的反应可预测OS、LRC和疾病进展时间（TTP）。C组患者的OS（P = 0.95）、LRC和DC相似，但TTP更差（P = 0.027）。
CRT前进行诱导化疗可减少远处进展，同时维持较高的LRC。B组方案提供了最佳治疗比。一项关于CRT前诱导化疗的随机试验已启动。
