Dimri Kislay, Pandey Awadhesh Kumar, Trehan Romeeta, Rai Bhavana, Kumar Anup
Department of Radiotherapy, Government Medical College, Chandigarh, India E-mail :
Asian Pac J Cancer Prev. 2013;14(11):6883-8. doi: 10.7314/apjcp.2013.14.11.6883.
Platinum based concurrent chemo-radiation is the de-facto standard of care in the non-surgical management of locally-advanced head and neck cancer of squamous origin. Three-weekly single agent cisplatin at 100 mg/m2 concurrent with radical radiotherapy has demonstrated consistent improvement in loco-regional control and survival. This improvement is however at the cost of considerable hematologic toxicity and poor overall compliance. The routine use of this regime is improbable in developing countries with limited resources. We therefore aimed to determine the safety and efficacy of an alternative regime of weekly cisplatin and concurrent radiotherapy in such patients.
January-05 and April-12, 188 patients of locally-advanced head and neck cancer of squamous origin were treated with concurrent weekly-cisplatin at 35 mg/m2 and conventional radiotherapy 60-66Gy/30-33 fractions/5 days per week.
Overall, 95% patients received planned doses of RT while 74% completed within the stipulated overall treatment time of <50 days. Eighty-two percent received at-least 5 weekly cycles. Grade-III/IV mucositis was seen in 58%/9% respectively, which resulted in mean weight loss of 9.2% from a pre-treatment mean of 54.5 kg. Grade-III hematologic toxicity-0.5%; grade II nephrotoxicity-2.5% and grade III emesis-3% were also seen. Grade-III/IV subcutaneous toxicity-10%/1% and grade-III/IV xerostomia-10%/0% were observed. Complete responses at the primary site, regional nodes and overall disease were seen in 86%, 89% and 83% patients respectively. The median and 5-years disease-free survival were 26 months and 39.4% respectively, while the median and overall survival were 27 months and 41.8% respectively.
Weekly-cisplatin at 35 mg /m2 when delivered concurrently with conventional radical RT (at-least 66y/33 fractions) in locally-advanced head and neck cancer is well tolerated with minimal hematologic and neprologic toxicity and can be routinely delivered on an out-patient basis. It is an effective alternative to the standard 3-weekly cisplatin especially in the context of developing countries.
基于铂类的同步放化疗是局部晚期鳞状上皮源性头颈部癌非手术治疗的实际标准治疗方案。每三周一次给予100mg/m²的单药顺铂并同步进行根治性放疗已显示出在局部区域控制和生存率方面持续的改善。然而，这种改善是以相当大的血液学毒性和总体依从性差为代价的。在资源有限的发展中国家，这种治疗方案的常规使用不太可能实现。因此，我们旨在确定在这类患者中每周一次顺铂与同步放疗的替代方案的安全性和有效性。
在2005年1月至2012年4月期间，188例局部晚期鳞状上皮源性头颈部癌患者接受了每周一次35mg/m²顺铂与常规放疗（60 - 66Gy/30 - 33次分割/每周5天）的同步治疗。
总体而言，95%的患者接受了计划剂量的放疗，74%的患者在规定的总治疗时间<50天内完成治疗。82%的患者接受了至少5个每周周期的治疗。分别有58%/9%的患者出现III/IV级黏膜炎，这导致平均体重从治疗前的54.5kg下降了9.2%。还观察到III级血液学毒性为0.5%；II级肾毒性为2.5%，III级呕吐为3%。观察到III/IV级皮下毒性为10%/1%，III/IV级口干为10%/0%。分别有86%、89%和83%的患者在原发部位、区域淋巴结和总体疾病方面达到完全缓解。中位无病生存期和5年无病生存率分别为26个月和39.4%，而中位总生存期和总生存率分别为27个月和41.8%。
在局部晚期头颈部癌患者中，每周一次给予35mg/m²顺铂并与常规根治性放疗（至少66y/33次分割）同步进行时，耐受性良好，血液学和肾毒性最小，并且可以在门诊常规进行。尤其是在发展中国家的背景下，它是标准的每三周一次顺铂方案的有效替代方案。
