Adelstein David J, Rodriguez Cristina P
Department of Solid Tumor Oncology, Cleveland Clinic Taussig Cancer Center, Cleveland, OH 44195, USA.
Semin Oncol. 2008 Jun;35(3):211-20. doi: 10.1053/j.seminoncol.2008.03.004.
Several different approaches have been tested in an effort to integrate chemotherapy into definitive non-operative management of squamous cell head and neck cancer. In phase III randomized trials and in meta-analyses, the concomitant use of chemotherapy and radiation has proven to be the most consistently successful, and to produce both locoregional control and survival benefits, when compared to radiation therapy alone. Large, multi-institutional and cooperative group studies have now established high-dose single-agent cisplatin and concurrent radiation therapy as the standard of care for patients with advanced nasopharynx cancer, for patients with unresectable head and neck tumors, and as a postoperative adjuvant for patients with high-risk pathologic features. This same treatment regimen also has been demonstrated to be the most effective multi-modality treatment strategy for larynx preservation. Future investigation will focus on optimizing the concomitant chemotherapy and radiotherapy schedules used, integrating targeted agents into these established treatment schedules, addressing the problem of distant metastases, minimizing both acute and late toxicities, and identifying the most appropriate patient populations for this kind of aggressive treatment.
为了将化疗纳入头颈部鳞状细胞癌的确定性非手术治疗中，已经对几种不同的方法进行了测试。在III期随机试验和荟萃分析中，与单纯放射治疗相比，化疗与放疗联合使用已被证明是最持续成功的方法，并且能产生局部区域控制和生存获益。大型、多机构和合作组研究现已确立，高剂量单药顺铂和同步放疗是晚期鼻咽癌患者、不可切除的头颈部肿瘤患者的标准治疗方法，也是具有高危病理特征患者的术后辅助治疗方法。同样的治疗方案也已被证明是保喉最有效的多模式治疗策略。未来的研究将集中于优化所用的同步化疗和放疗方案，将靶向药物纳入这些既定的治疗方案中，解决远处转移问题，将急性和晚期毒性降至最低，以及确定最适合这种积极治疗的患者群体。
