Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI, USA.
Int J Radiat Oncol Biol Phys. 2012 Jun 1;83(2):690-5. doi: 10.1016/j.ijrobp.2011.06.2010. Epub 2011 Nov 21.
To examine the efficacy and toxicity of continuous-course, conformal reirradiation with weekly paclitaxel and carboplatin for the treatment of locally recurrent, nonmetastatic squamous cell carcinoma of the head and neck (SCCHN) in a previously irradiated field.
Patients treated with continuous course-reirradiation with concurrent carboplatin and paclitaxel at the Medical College of Wisconsin and the Clement J. Zablocki VA from 2001 through 2009 were retrospectively reviewed. Patients included in the analysis had prior radiation at the site of recurrence of at least 45 Gy. The analysis included patients who received either intensity-modulated radiotherapy (RT) or three-dimensional conformal RT techniques. All patients received weekly concurrent carboplatin (AUC2) and paclitaxel (30-50 mg/m(2)).
Thirty-eight patients with nonmetastatic SCCHN met the entry criteria for analysis. The primary sites at initial diagnosis were oropharyngeal or laryngeal in most patients (66%). Median reirradiation dose was 60 Gy (range, 54-70 Gy). Acute toxicity included Grade 2 neutropenia (5%), Grade 3 neutropenia (15%), and Grade 1/2 thrombocytopenia (8%). No deaths occurred from hematologic toxicity. Chemotherapy doses held (50%) was more prevalent than radiation treatment break (8%). Sixty-eight percent of patients required a gastrostomy tube in follow-up. Significant late toxicity was experienced in 6 patients (16%): 1 tracheoesophageal fistula, 1 pharyngocutaneous fistula, 3 with osteoradionecrosis, and 1 patient with a lingual artery bleed. Patients treated with three-dimensional conformal RT had more frequent significant late toxicites than patients treated with intensity-modulated RT (44% and 7% respectively, p < 0.05). The median time to progression was 7 months and progression-free rates at 1, 2, and 5 years was 44%, 34%, and 29% respectively. The median overall survival was 16 months. Overall survival at 1, 3, and 5 years was 54%, 31%, and 20% respectively.
Continuous-course, conformal reirradiation with weekly paclitaxel and carboplatin has an acceptable toxicity profile and offers a potentially curative option in a subset of patients with few other options.
研究每周紫杉醇和卡铂联合持续疗程适形再放疗治疗既往照射野内局部复发、非转移性头颈部鳞癌（SCCHN）的疗效和毒性。
对 2001 年至 2009 年在威斯康星医学院和克莱门特·J·扎布洛基退伍军人事务部接受持续疗程再放疗联合卡铂和紫杉醇治疗的患者进行回顾性分析。入组分析的患者在复发部位均接受了至少 45Gy 的放射治疗。分析包括接受调强放疗（RT）或三维适形 RT 技术的患者。所有患者均接受每周同步卡铂（AUC2）和紫杉醇（30-50mg/m2）治疗。
38 例非转移性 SCCHN 患者符合分析纳入标准。初次诊断时的原发部位多为口咽或喉（66%）。中位再放疗剂量为 60Gy（范围 54-70Gy）。急性毒性包括 2 级中性粒细胞减少（5%）、3 级中性粒细胞减少（15%）和 1/2 级血小板减少（8%）。无因血液学毒性死亡。化疗剂量中断（50%）比放疗中断（8%）更常见。68%的患者在随访中需要胃造口管。6 例（16%）发生严重迟发性毒性：1 例气管食管瘘、1 例咽皮瘘、3 例放射性骨坏死和 1 例舌动脉出血。接受三维适形 RT 治疗的患者比接受调强 RT 治疗的患者更常发生严重迟发性毒性（分别为 44%和 7%，p<0.05）。中位无进展时间为 7 个月，1、2 和 5 年无进展生存率分别为 44%、34%和 29%。中位总生存时间为 16 个月。1、3 和 5 年总生存率分别为 54%、31%和 20%。
每周紫杉醇和卡铂联合持续疗程适形再放疗具有可接受的毒性谱，并为少数其他治疗选择有限的患者提供了一种潜在的治愈选择。
