Lorch Jochen H, Posner Marshall R, Wirth Lori J, Haddad Robert I
Dana Farber Cancer Institute, SW430, 44 Binney Street, Boston, MA 02115, USA.
Hematol Oncol Clin North Am. 2008 Dec;22(6):1155-63, viii. doi: 10.1016/j.hoc.2008.08.004.
Locally advanced squamous cell cancer of the head and neck is a major contributor to morbidity and mortality worldwide. Despite progress through the use of multimodality treatment involving surgery, radiotherapy, and chemotherapy in recent years, the survival remains poor, and treatment-related morbidity-mainly caused by radiation-induced effects such as soft tissue scarring, esophageal stenosis, xerostomia, dental decay, and osteoradionecrosis-is a major problem in long-term survivors. Data from early trials and encouraging results from meta-analyses have revived interest in the use of neoadjuvant or induction chemotherapy before definitive local treatment. Recent randomized trials have demonstrated marked improvements in survival with the addition of the taxane docetaxel (Taxotere) to the traditional induction regimen consisting of cisplatin and 5FU (TPF) compared with cisplatin and 5FU (PF) alone and have established a new standard of care. The newer TPF induction chemotherapy regimens also appear to be tolerated better than PF when accompanied by adequate supportive measures. Studies to enhance the efficacy of TPF induction chemotherapy by adding new targeted agents, such as the EGF-R inhibitors cetuximab and panitumumab, are underway.
局部晚期头颈部鳞状细胞癌是全球发病和死亡的主要原因。尽管近年来通过采用包括手术、放疗和化疗在内的多模式治疗取得了进展，但生存率仍然很低，而且与治疗相关的发病率——主要由辐射诱导的效应如软组织瘢痕形成、食管狭窄、口干、龋齿和放射性骨坏死引起——是长期存活者的一个主要问题。早期试验的数据和荟萃分析的鼓舞人心的结果重新激发了人们对在确定性局部治疗前使用新辅助或诱导化疗的兴趣。最近的随机试验表明，与单独使用顺铂和5-氟尿嘧啶（PF）相比，在由顺铂和5-氟尿嘧啶组成的传统诱导方案（TPF）中加入紫杉烷多西他赛（泰索帝）可显著提高生存率，并确立了新的治疗标准。当有足够的支持措施时，更新的TPF诱导化疗方案似乎也比PF耐受性更好。通过添加新的靶向药物（如表皮生长因子受体抑制剂西妥昔单抗和帕尼单抗）来提高TPF诱导化疗疗效的研究正在进行中。
