Department of Medicine and Cancer Research Center, The University of Chicago Medical Center, Chicago, Illinois 60637, USA.
Oncologist. 2010;15 Suppl 3:3-7. doi: 10.1634/theoncologist.2010-S3-03.
The addition of chemotherapy to radiotherapy in the treatment of locally advanced squamous cell carcinoma of the head and neck (SCCHN) patients improves survival. Meta-analyses of randomized trials have indicated that the benefit of this approach is associated with the timing of chemotherapy administration. It has been demonstrated that the greatest survival benefit over locoregional treatment alone is seen with the concurrent administration of chemotherapy and radiotherapy. However, sequential chemotherapy administration, in the form of induction chemotherapy followed by radiotherapy or concurrent chemoradiotherapy, has been successful as a strategy for organ function preservation in patients with potentially resectable SCCHN. In addition, a meta-analysis of trials using platinum and 5-fluorouracil (PF)-containing induction regimens demonstrated a significant survival benefit for this approach over locoregional treatment alone in locally advanced disease. In recent years, the introduction of the taxanes into induction chemotherapy has provided physicians with more active regimens. The triplet combination induction regimen of docetaxel, cisplatin, and 5-fluorouracil has been shown to be more effective in prolonging survival than the doublet PF. Current trials are testing whether the addition of induction chemotherapy to standard concomitant chemoradiotherapy is superior to concomitant chemoradiotherapy alone.
放化疗联合治疗局部晚期头颈部鳞状细胞癌（SCCHN）患者可提高生存率。随机试验的荟萃分析表明，这种方法的益处与化疗给药时机有关。已经证明，与单纯局部区域治疗相比，联合放化疗可带来最大的生存获益。然而，序贯化疗（诱导化疗后放疗或同期放化疗）作为潜在可切除 SCCHN 患者的器官功能保存策略已取得成功。此外，一项使用铂类和氟尿嘧啶（PF）联合诱导方案的试验荟萃分析表明，与单纯局部区域治疗相比，该方法在局部晚期疾病中有显著的生存获益。近年来，紫杉烷类药物在诱导化疗中的应用为医生提供了更有效的方案。多西紫杉醇、顺铂和氟尿嘧啶三联诱导方案在延长生存方面比 PF 二联方案更有效。目前的试验正在测试诱导化疗联合标准同步放化疗是否优于单纯同步放化疗。
