Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, USA.
Cancer. 2011 Oct 15;117(20):4671-8. doi: 10.1002/cncr.26084. Epub 2011 Jun 13.
It has been shown that concomitant chemotherapy (C) with reirradiation (ReRT) is feasible and effective for select patients with recurrent or second primary head and neck cancer (HNC). To examine potential prognostic factors associated with survival, the authors of this report retrospectively reviewed the outcomes of patients who received CReRT.
The study cohort comprised previously irradiated patients with nonmetastatic disease from 9 consecutive phase 1 and 2 protocols for poor-prognosis HNC. For all patients, reirradiation (ReRT) was delivered with concurrent chemotherapy. Chemotherapy generally was 5-fluorouracil, hydroxyurea, and a third agent.
One hundred sixty-six patients were identified, including 81 patients who underwent surgical resection or debulking before enrollment. The median ReRT dose was 66 gray. After a median follow-up of 53 months among surviving patients, the median overall survival (OS) was 10.3 months. The 2-year rates for OS, disease-free survival, locoregional control, and freedom from distant metastasis were 24.8%, 19.9%, 50.7%, and 61.4%, respectively. Thirty-three patients (19.9%) died of treatment-related toxicity. In subgroup analysis, survival was significantly reduced in patients who received previous concurrent chemoradiotherapy (CRT) compared with patients who were naive to CRT (2-year OS rate, 10.8% vs 28.4%; P = .0043). In multivariable analysis, prior CRT was associated independently with OS along with surgery before protocol treatment, full-dose ReRT, and radiotherapy interval.
CReRT achieved a long-term cure for a small group of patients with recurrent or second primary HNC. Previous treatment with CRT was among the important prognostic factors for survival. Because of the associated risk of severe toxicity, CReRT should be limited only to carefully selected patients.
已经证明，对于选择的复发性或第二原发性头颈部癌症（HNC）患者，同时进行化疗（C）和再放疗（ReRT）是可行且有效的。为了研究与生存相关的潜在预后因素，作者回顾性分析了接受 CReRT 的患者的结局。
研究队列包括 9 项连续的 1 期和 2 期不良预后 HNC 方案中接受过放疗的无转移疾病患者。所有患者均接受同步化疗的再放疗（ReRT）。化疗通常为氟尿嘧啶、羟基脲和第三种药物。
共确定了 166 例患者，其中 81 例患者在入组前接受了手术切除或减瘤。中位 ReRT 剂量为 66 格雷。在生存患者的中位随访时间为 53 个月后，中位总生存期（OS）为 10.3 个月。2 年 OS、无疾病生存、局部区域控制和无远处转移率分别为 24.8%、19.9%、50.7%和 61.4%。33 例（19.9%）患者死于治疗相关毒性。亚组分析显示，与 CRT 初治患者相比，先前接受过同期放化疗（CRT）的患者生存显著降低（2 年 OS 率，10.8%对 28.4%；P =.0043）。多变量分析显示，先前的 CRT 与 OS 独立相关，与方案治疗前的手术、全剂量 ReRT 和放疗间隔有关。
CReRT 为少数复发性或第二原发性 HNC 患者实现了长期治愈。先前接受 CRT 治疗是生存的重要预后因素之一。由于严重毒性的风险，CReRT 应仅限制在精心选择的患者中。
