Department of Oral and Maxillofacial Surgery, Kumamoto University Hospital, Honjo, Kumamoto, Japan.
Int J Radiat Oncol Biol Phys. 2010 Apr;76(5):1347-52. doi: 10.1016/j.ijrobp.2009.03.055. Epub 2009 Jul 21.
To determine the feasibility and efficacy of preoperative concurrent chemoradiation therapy (CCRT) with S-1, an oral fluoropyrimidine derivative, in patients with T4 oral squamous cell carcinoma (SCC).
Only patients with histologically proven T4 oral SCC were included. Radiotherapy (total dose, 30 Gy) was delivered in 2-Gy daily fractions over a period of 3 weeks. Concurrently, S-1 (80 mg/m(2)/day) was administered orally twice daily for 14 consecutive days.
We enrolled 46 patients. All underwent radiotherapy as planned; however, oral S-1 was discontinued in 3 patients who manifested acute toxicity. Grade 3 toxicities were mucositis (20%), anorexia (9%), and neutropenia (4%). We encountered no Grade 4 adverse events or serious postoperative morbidity requiring surgical intervention. After CCRT, 32 of the 46 patients underwent radical resection; in 17 (53%) of the operated patients, the pathologic response was complete. During follow-up ranging from 7 to 58 months (median, 22 months), tumor control failed in 5 (16%) of the 32 operated patients; there were 3 local and 2 regional failures. Of the 14 non-operated patients, 8 (57%) manifested local (n = 7) or regional failure (n = 1). The 3-year overall survival rate for all 46 patients was 69%; it was significantly higher for operated than for non-operated patients (82% vs. 48%; p = 0.0288).
Preoperative CCRT with S-1 is feasible and effective in patients with T4 oral SCC. Even in inoperable cases, CCRT with S-1 provides adequate tumor control.
评估替吉奥（S-1）联合术前放化疗治疗 T4 期口腔鳞状细胞癌（SCC）的可行性和疗效。
仅纳入经组织学证实的 T4 期口腔 SCC 患者。放疗（总剂量 30Gy）采用 2Gy 单次剂量，3 周内完成。同期给予 S-1（80mg/m2/天）口服，每日 2 次，连续 14 天。
共纳入 46 例患者。所有患者均按计划接受放疗；然而，由于 3 例患者出现急性毒性，停止了口服 S-1 治疗。3 级毒性包括黏膜炎（20%）、食欲不振（9%）和中性粒细胞减少症（4%）。未发生 4 级不良事件或需要手术干预的严重术后并发症。在 CCRT 后，46 例患者中有 32 例接受了根治性切除术；在 17 例（53%）接受手术的患者中，病理反应完全。在 7-58 个月（中位 22 个月）的随访期间，32 例接受手术的患者中有 5 例（16%）肿瘤控制失败；其中 3 例为局部失败，2 例为区域失败。在 14 例未手术的患者中，8 例（57%）出现局部（n=7）或区域失败（n=1）。46 例患者的 3 年总生存率为 69%；手术组明显高于未手术组（82%比 48%；p=0.0288）。
S-1 联合术前放化疗治疗 T4 期口腔 SCC 是可行和有效的。即使在不可手术的情况下，S-1 联合 CCRT 也能提供充分的肿瘤控制。
