Izawa Naoki, Onozawa Yusuke, Hikosaka Tomomi, Hamauchi Satoshi, Tsushima Takahiro, Todaka Akiko, Machida Nozomu, Haraguchi Yutaka, Ogawa Hirofumi, Nishimura Tetsuo, Nakagawa Masahiro, Fuke Tomohito, Iida Yoshiyuki, Kamijo Tomoyuki, Onitsuka Tetsuro, Boku Narikazu, Yasui Hirofumi, Yokota Tomoya
Division of Gastrointestinal Oncology, Shizuoka Cancer Center, 1007 Shimonagakubo Nagaizumi Sunto-gun, Shizuoka, 411-8777, Japan.
Int J Clin Oncol. 2015 Jun;20(3):455-62. doi: 10.1007/s10147-014-0749-4. Epub 2014 Sep 25.
We evaluated the efficacy and feasibility of docetaxel, cisplatin, and 5-fluorouracil (TPF) induction chemotherapy followed by concurrent chemoradiotherapy (CRT) for locally advanced head and neck squamous cell carcinoma (HNSCC) with a high risk of distant metastases compared with CRT alone.
We retrospectively analyzed 29 HNSCC patients with clinical nodal stage N2c, N3, or N2b disease and supraclavicular lymph node metastases receiving CRT alone (CRT group; n = 16) or TPF induction chemotherapy followed by CRT (TPF group; n = 13) between April 2008 and May 2012.
The median follow-up periods were 14.5 (range 5.0-65.0) and 25.0 (range 14.0-32.0) months for CRT and TPF groups, respectively. A greater proportion of patient characteristics in the CRT group had advanced T and N stages. The overall response rate to induction TPF was 50.0%; grade 3-4 toxicities included neutropenia, febrile neutropenia, anorexia, and hyponatremia. Complete response rates after CRT completion were 55.5% in the TPF and 42.9% in the CRT group; median overall survival was not reached in the TPF group and was 14.0 months in the CRT group (p = 0.037). Multivariate analysis revealed that induction TPF and T stage were independent prognostic factors [hazard ratio (HR) = 0.196; 95% confidence interval (CI) 0.043-0.898; p = 0.036, HR = 9.966; 95% CI 2.270-43.75; p = 0.002, respectively).
TPF followed by CRT is tolerated and may be an option for the treatment of locally advanced stage N2c, N3, or N2b HNSCC.
我们评估了多西他赛、顺铂和5-氟尿嘧啶（TPF）诱导化疗后序贯同步放化疗（CRT）用于远处转移风险高的局部晚期头颈部鳞状细胞癌（HNSCC）的疗效和可行性，并与单纯CRT进行比较。
我们回顾性分析了2008年4月至2012年5月期间29例临床淋巴结分期为N2c、N3或N2b且有锁骨上淋巴结转移的HNSCC患者，其中16例接受单纯CRT（CRT组），13例接受TPF诱导化疗后序贯CRT（TPF组）。
CRT组和TPF组的中位随访时间分别为14.5（范围5.0 - 65.0）个月和25.0（范围14.0 - 32.0）个月。CRT组中更多患者特征为T和N分期较晚。诱导TPF的总体缓解率为50.0%；3 - 4级毒性包括中性粒细胞减少、发热性中性粒细胞减少、厌食和低钠血症。CRT完成后的完全缓解率在TPF组为55.5%，在CRT组为42.9%；TPF组未达到中位总生存期，CRT组为14.0个月（p = 0.037）。多因素分析显示诱导TPF和T分期是独立的预后因素[风险比（HR）= 0.196；95%置信区间（CI）0.043 - 0.898；p = 0.036，HR = 9.966；95% CI 2.270 - 43.75；p = 0.002，分别]。
TPF后序贯CRT耐受性良好，可能是治疗局部晚期N2c、N3或N2b期HNSCC的一种选择。
