Dobrowsky W, Dobrowsky E, Strassl H, Braun O, Scheiber V
Department of Radiotherapy and Radiobiology, University of Vienna, Austria.
Eur J Cancer Clin Oncol. 1989 May;25(5):845-9. doi: 10.1016/0277-5379(89)90130-2.
Advanced head and neck tumours have a poor prognosis due to the high frequency of local recurrence. Multimodality treatment has been shown to be effective in decreasing local recurrence. In this study, 51 patients with advanced oral and oropharyngeal carcinoma were entered in a trial of preoperative radio-chemotherapy. After exclusion of -10 protocol violations (no surgery or no chemotherapy), 41 patients remained evaluable. Chemotherapy consisted of 15 mg mitomycin C/m2 given intravenously (bolus) on day 1. 5-Fluorouracil (750 mg/m2/24 h) was infused during days 1-5 (continuous infusion for 120 h). Radiotherapy was performed simultaneously with chemotherapy beginning on day 1. A total dose of 50 Gy to the primary tumour and neck region was delivered over 5 weeks. Treatment was well tolerated. Side-effects were mainly of local character (mucositis). No severe systemic toxicity was seen. Some delayed wound healing was noted at the operation (4 weeks after irradiation). The CR rate of the primary tumours was 56% (23/41). In 39% (16/41) only histological residual tumour was found. Two patients had minor response (categorized as NR) of their tumour (macroscopic residual tumour). None had tumour progression. The response rates considering lymph node metastases were 59% (22/37) CR, 35% (13/37) PR and 5% (2/37) NR. After a follow up of 18-30 months, analysis of local recurrent disease and survival was performed. The loco-regional recurrence rate was 32% (13/41) and the survival rate 63% (26/41). All deceased patients, except two, died of tumour progression. Patients with T4 tumours showed inferior prognosis whereas no significant difference in survival of T2 and T3 patients was found. Patients with CR of tumour and lymph nodes (including NO) have all survived and are without evidence of disease.
由于局部复发频率高，晚期头颈部肿瘤预后较差。多模式治疗已被证明可有效降低局部复发率。在本研究中，51例晚期口腔和口咽癌患者进入术前放化疗试验。排除10例方案违规（未手术或未化疗）后，41例患者仍可评估。化疗包括在第1天静脉推注15mg丝裂霉素C/m²。在第1 - 5天输注5-氟尿嘧啶（750mg/m²/24h）（持续输注120小时）。放疗与化疗同时在第1天开始。对原发肿瘤和颈部区域给予50Gy的总剂量，分5周进行。治疗耐受性良好。副作用主要为局部性（粘膜炎）。未观察到严重的全身毒性。手术时（放疗后4周）发现一些伤口愈合延迟。原发肿瘤的完全缓解（CR）率为56%（23/41）。39%（16/41）仅发现组织学残留肿瘤。2例患者肿瘤有轻微反应（归类为疾病未缓解，NR）（肉眼可见残留肿瘤）。无患者出现肿瘤进展。考虑淋巴结转移的缓解率为CR 59%（22/37）、部分缓解（PR）35%（13/37）和NR 5%（2/37）。在随访18 - 30个月后，对局部复发性疾病和生存率进行了分析。局部区域复发率为32%（13/41），生存率为63%（26/41）。除2例外，所有死亡患者均死于肿瘤进展。T4期肿瘤患者预后较差，而T2和T3期患者生存率无显著差异。肿瘤和淋巴结（包括N0）达到CR的患者均存活且无疾病证据。
