Al Sarraf M D, El Hariry I
Williams Beaumont Hospital, Royal Oak, Michigan, USA.
Gulf J Oncolog. 2008 Jul(4):8-18.
Induction CT have evolved since its introduction in the mid of 1970s for patients with previously untreated locally advanced HNC. We went from single agent cisplatin to cisplatin bleomycin combinations, to PF and now to the three drugs combination of TPF or its safer modification. We started with single cycle of induction CT, to two courses and now the best to give is the three cycles of CT. We not only improved on the effectiveness of the induction CT, but also reduced the possible side effects and improved the quality of life for those receiving such treatment. Induction CT followed by RT alone is superior to RT only in patients with previously untreated unresectable/inoperable HNC. Although, the "standard" of care of these patients today is concurrent CT+RT. Induction TPF followed by the best local treatment(s) usually concurrent CT+RT was superior to PF followed by the best local therapy in these patients. Will this mean that in patients with locally advanced unresectable/inoperable HNC induction TPF followed by concurrent CT+RT is the treatment of choice, in our opinion is yes, but this is not acceptable by the majority of investigators. This is why we do have more than four prospective randomized phase III trials trying to answer such an important question. In our opinion and strong believe that all patients with locally advanced HNC including patients with NPC not on active protocol(s) may be offered induction three drugs combination followed by concurrent CT+RT as their primary planned treatment. In those patients who are resectable/operable before any such therapy and did not respond (CR or PR) to such induction CT may offer surgical resection followed by post-operative concurrent CT + RT. Table 5 summarize the rational of the continue use of the total treatment of induction CT followed by concurrent CT+RT in patients with previously untreated and locally advanced HNC.
自20世纪70年代中期引入以来，诱导化疗已在先前未经治疗的局部晚期头颈部癌患者中不断发展。我们从单一顺铂药物治疗发展到顺铂与博来霉素联合治疗，再到PF方案，现在则是TPF三种药物联合方案或其更安全的改良方案。我们从单周期诱导化疗开始，发展到两个疗程，现在最佳的是三个疗程的化疗。我们不仅提高了诱导化疗的疗效，还减少了可能的副作用，并改善了接受此类治疗患者的生活质量。对于先前未经治疗的不可切除/无法手术的头颈部癌患者，诱导化疗后单纯放疗优于单纯放疗。尽管如今这些患者的“标准”治疗是同步放化疗。在这些患者中，诱导TPF方案后采用最佳的局部治疗（通常是同步放化疗）优于PF方案后采用最佳局部治疗。在我们看来，这是否意味着对于局部晚期不可切除/无法手术的头颈部癌患者，诱导TPF方案后同步放化疗是首选治疗方法呢？答案是肯定的，但大多数研究者并不认同。这就是为什么我们有超过四项前瞻性随机III期试验试图回答这个重要问题。我们认为并坚信，所有局部晚期头颈部癌患者，包括未参与积极方案的鼻咽癌患者，都可以接受诱导三种药物联合方案，然后同步放化疗作为其主要的计划性治疗。对于那些在任何此类治疗前可切除/可手术且对诱导化疗无反应（完全缓解或部分缓解）的患者，可进行手术切除，然后术后同步放化疗。表5总结了在先前未经治疗的局部晚期头颈部癌患者中持续采用诱导化疗后同步放化疗的总体治疗原理。
