Yoshizaki Tomokazu, Kondo Satoru, Wakisaka Naohiro, Murono Shigeyuki, Kitagawa Noriko, Tsuji Akira, Nakashima Masashi, Sanada Jun-ichiro, Matsui Osamu
Division of Otolaryngology, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan.
Ann Otol Rhinol Laryngol. 2009 Mar;118(3):172-8. doi: 10.1177/000348940911800303.
An intra-arterial chemoradiotherapy regimen (RADPLAT) provides remarkable local control for head and neck cancer. This study evaluates the efficacy of a reduced RADPLAT protocol in patients who are candidates for total laryngectomy.
Forty-three patients with advanced laryngeal cancer were treated with 2 courses of intra-arterial cisplatin infusion (100 mg per body) during 40-Gy irradiation. The patients who showed a greatly diminished tumor received sequential irradiation. The patients with obvious residual disease received chemotherapy during the sequential irradiation. Poor responders, with less than 50% tumor reduction, underwent total laryngectomy.
Forty-two patients completed the protocol. All surviving patients were followed for at least 3 years. Thirty-four patients were alive (80% of the supraglottic cases and 87.5% of the glottic cases). Local control was achieved in 27 patients (67.5% of the 11 glottic cases and 64.0% of the supraglottic cases). The glottic cohort showed better progression-free survival rates than did the supraglottic cohort (68.8% and 45.0%, respectively; p = 0.019). There were 2 cases of grade 3 neutropenia and 3 cases of grade 3 mucositis. No patients required tube feeding. One patient required tracheostomy 3 months after the completion of the treatment protocol.
Concurrent chemoradiotherapy with a reduced dose of intra-arterial cisplatin is feasible for patients with advanced glottic cancer.
动脉内放化疗方案（RADPLAT）对头颈部癌具有显著的局部控制效果。本研究评估了简化的RADPLAT方案在拟行全喉切除术患者中的疗效。
43例晚期喉癌患者在40 Gy照射期间接受2个疗程的动脉内顺铂输注（每体质量100 mg）。肿瘤明显缩小的患者接受序贯照射。有明显残留病灶的患者在序贯照射期间接受化疗。反应较差（肿瘤缩小不足50%）的患者接受全喉切除术。
42例患者完成了该方案。所有存活患者均随访至少3年。34例患者存活（声门上型病例的80%和声门型病例的87.5%）。27例患者实现了局部控制（声门型病例中的11例，占67.5%；声门上型病例中的64.0%）。声门型队列的无进展生存率高于声门上型队列（分别为68.8%和45.0%；p = 0.019）。有2例3级中性粒细胞减少和3例3级黏膜炎。没有患者需要鼻饲。1例患者在治疗方案完成后3个月需要气管切开术。
对于晚期声门型癌患者，采用降低剂量的动脉内顺铂同步放化疗是可行的。
