Divisione di Oncologia Medica, Ospedale di Venezia e Mestre, Mestre-Venezia, Italy.
Oncologist. 2010;15 Suppl 3:8-12. doi: 10.1634/theoncologist.2010-S3-08.
There is increasing interest in the use of induction chemotherapy before concurrent chemotherapy and radiotherapy in the treatment of locally advanced head and neck cancer. A modest but significant improvement in survival has been observed with cisplatin and 5-fluorouracil (PF) induction before radiotherapy over that seen with radiotherapy alone. The addition of docetaxel to the PF regimen (TPF) appears to provide further survival benefits. The phase II part of a phase II/III trial compared three cycles of TPF induction chemotherapy before concomitant PF chemoradiotherapy with PF chemoradiotherapy alone in 101 patients with locally advanced stage III-IV head and neck cancer. The incidences of hematologic and nonhematologic toxicities during concurrent chemoradiotherapy were not higher in the TPF plus chemoradiotherapy group, and the feasibility of chemoradiotherapy was not compromised. Radiologically evaluated complete response rates at 6-8 weeks from the end of chemoradiotherapy (the primary endpoint) were 21% (95% confidence interval [CI], 11%-36%) with chemoradiotherapy alone and 50% (95% CI, 35%-65%; p = .004) with TPF plus chemoradiotherapy. A median overall survival time of 33.3 months and a 1-year survival rate of 78% were observed with chemoradiotherapy alone, whereas the median survival time was 39.6 months in the TPF plus chemoradiotherapy group, with a 1-year survival rate of 86%. To conclude, increasing evidence suggests that TPF induction chemotherapy improves clinical response and does not compromise subsequent chemoradiotherapy. The results of the ongoing phase III part of the phase II/III study should provide further information about the efficacy and safety of this approach for patients with locally advanced head and neck cancer.
越来越多的人对局部晚期头颈部癌症在同期放化疗前应用诱导化疗感兴趣。与单纯放疗相比，顺铂加氟尿嘧啶（PF）诱导化疗后再行放疗可观察到适度但显著的生存改善。多西紫杉醇联合 PF 方案（TPF）似乎提供了进一步的生存获益。一项 II/III 期临床试验的 II 期部分比较了 101 例局部晚期 III-IV 期头颈部癌症患者在同期 PF 放化疗前接受 3 个周期 TPF 诱导化疗与单纯 PF 放化疗的疗效。在 TPF 联合放化疗组中，同期放化疗期间血液学和非血液学毒性的发生率并不高于单纯放化疗组，放化疗的可行性并未受到影响。从放化疗结束后 6-8 周（主要终点）评估的影像学完全缓解率，单纯放化疗组为 21%（95%可信区间，11%-36%），TPF 联合放化疗组为 50%（95%可信区间，35%-65%；p=0.004）。单纯放化疗组的中位总生存时间为 33.3 个月，1 年生存率为 78%，而 TPF 联合放化疗组的中位生存时间为 39.6 个月，1 年生存率为 86%。总之，越来越多的证据表明 TPF 诱导化疗可提高临床反应，且不会影响随后的放化疗。正在进行的 II/III 期临床试验 III 期部分的结果将进一步提供关于这种方法治疗局部晚期头颈部癌症的疗效和安全性的信息。
