Department of Radiation Therapy and Oncology, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany.
Strahlenther Onkol. 2014 Mar;190(3):256-62. doi: 10.1007/s00066-013-0509-9. Epub 2014 Jan 12.
Despite the lack of evidence to support its implementation in the clinical practice, induction chemotherapy (IC) before chemoradiotherapy (CRT) is often used in patients with locally advanced squamous cell carcinoma of the head and neck (SCCHN). We retrospectively examined the tolerability, feasibility, and clinical outcome of both concepts in a single center analysis.
In all, 83 patients were treated between 2007 and 2010 with IC + CRT (n = 42) or CRT alone (n = 41). IC consisted of docetaxel, cisplatin and 5-fluorouracil (TPF), or cisplatin and 5-fluorouracil (PF). All patients were scheduled to receive 2 cycles of PF during concurrent CRT. Adverse events were assessed according to the common toxicity criteria of adverse events (CTCAE v. 3.0). Associations were tested using the χ² test, and survival estimates were calculated according to Kaplan-Meier.
The median follow-up was 30.35 months (range 2.66-61.25 months). At 2 years, the overall survival rate was significantly higher for primary CRT compared to IC + CRT group (74.8 % vs. 54 %, respectively; p = 0.041). Significantly more treatment-related overall grade 4 toxicities were documented in the IC + CRT group compared to the CRT group (42.9% vs. 9.8%; p = 0.001). Renal toxicity ≥ grade 2 occurred in 52.4 % vs. 7.3 % (p < 0.001), respectively. In all, 93 % of the patients with primary CRT compared to 71 % with IC + CRT received the planned full radiotherapy dose (p = 0.012).
This is, to our knowledge, the largest retrospective study to compare IC + CRT with primary CRT. IC showed high acute toxicity, compromised the feasibility of concurrent CRT, and was associated with reduced overall survival rates compared to primary CRT. The lack of clinical benefit in conjunction with the increased toxicity does not support implementation of IC.
尽管没有证据支持其在临床实践中的应用，但诱导化疗（IC）在前化学放射治疗（CRT）之前经常用于局部晚期头颈部鳞状细胞癌（SCCHN）患者。我们在单中心分析中回顾性检查了这两种概念的耐受性、可行性和临床结果。
2007 年至 2010 年间，共有 83 例患者接受 IC + CRT（n = 42）或单纯 CRT（n = 41）治疗。IC 由多西他赛、顺铂和 5-氟尿嘧啶（TPF）或顺铂和 5-氟尿嘧啶（PF）组成。所有患者均计划在 CRT 期间接受 2 个周期的 PF。不良反应根据不良事件通用毒性标准（CTCAE v.3.0）进行评估。使用 χ²检验检验关联，根据 Kaplan-Meier 计算生存估计。
中位随访时间为 30.35 个月（范围 2.66-61.25 个月）。2 年时，原发 CRT 的总生存率明显高于 IC + CRT 组（分别为 74.8%和 54%；p = 0.041）。IC + CRT 组与 CRT 组相比，记录到更多的治疗相关总 4 级毒性（42.9%对 9.8%；p = 0.001）。≥2 级肾毒性分别为 52.4%和 7.3%（p < 0.001）。原发 CRT 的患者中有 93%与 IC + CRT 的患者中有 71%接受了计划的全放疗剂量（p = 0.012）。
这是我们所知的比较 IC + CRT 与原发 CRT 的最大回顾性研究。IC 显示出高急性毒性，使同期 CRT 的可行性受到影响，并与原发 CRT 相比，总生存率降低相关。缺乏临床获益加上毒性增加不支持实施 IC。
