Department of Radiological Science, University of Messina, Messina, Italy.
Radiat Oncol. 2011 Nov 22;6:162. doi: 10.1186/1748-717X-6-162.
to evaluate activity and toxicity of a sequential treatment in advanced, non metastatic, mostly unresectable, head and neck squamous cell carcinoma.
Patients with loco-regionally advanced or unresectable, head and neck cancer, were prospectively treated with 3 courses of induction chemotherapy followed by concurrent chemoradiation. Induction chemotherapy consisted of paclitaxel 175 mg/m2 day 1 and cisplatin 75 mg/m2 day 2, given every 3 weeks, to a total of three courses. Curative radiotherapy started 4 weeks after the last cycle of chemotherapy with the goal of delivering a total dose ≥ 66 Gy. During RT weekly paclitaxel (40 mg/m2) was administered.
The trial accrued 43 patients from January 1999 to December 2002. All patients received 3 courses of induction chemotherapy and the planned dose of radiotherapy. Thirty-eight patients were able to tolerate weekly paclitaxel during irradiation at least for 4 courses. After induction therapy there were 32 overall responses, 74.4% (23 partial and 9 complete); at completion of concomitant treatment overall responses were 42, 97.7% (20 partial and 22 complete). Median time to treatment failure was 20 months and the disease progression rate at 3 and 5 years was 33% and 23%, respectively. The median overall survival time was 24 months and 3 and 5 years overall survival rates were 37% and 26%, respectively. The major toxicity was mucositis.
This combined treatment was found to be feasible and active in advanced or unresectable, head and neck squamous cell carcinoma patients. Long-term results observed in this trial encourage to consider this approach in further investigation using newer radiation delivering technique and new molecularly agents.
评估序贯治疗晚期、非转移性、多数不可切除的头颈部鳞状细胞癌的疗效和毒性。
局部晚期或不可切除的头颈部癌症患者，前瞻性地接受 3 个疗程的诱导化疗，随后进行同期放化疗。诱导化疗方案为紫杉醇 175 mg/m2，第 1 天；顺铂 75 mg/m2，第 2 天，每 3 周给药 1 次，共 3 个疗程。化疗结束后 4 周开始根治性放疗，目标剂量为≥66 Gy。在 RT 期间每周给予紫杉醇（40 mg/m2）。
该试验于 1999 年 1 月至 2002 年 12 月共入组 43 例患者。所有患者均接受了 3 个疗程的诱导化疗和计划的放疗剂量。38 例患者能够耐受放疗期间每周紫杉醇至少 4 个疗程。诱导治疗后，总缓解率为 32 例，74.4%（23 例部分缓解，9 例完全缓解）；同期治疗结束时，总缓解率为 42 例，97.7%（20 例部分缓解，22 例完全缓解）。中位无进展生存期为 20 个月，3 年和 5 年疾病进展率分别为 33%和 23%。中位总生存期为 24 个月，3 年和 5 年总生存率分别为 37%和 26%。主要毒性为粘膜炎。
这种联合治疗对头颈部鳞状细胞癌晚期或不可切除患者是可行且有效的。本试验观察到的长期结果鼓励采用更新的放射治疗技术和新的分子靶向药物进一步研究这种治疗方法。
