Jacobs M C, Eisenberger M, Oh M C, Sinibaldi V, Gray W, Elias G, Salazar O M
University of Maryland Medical Systems, Baltimore 21201.
Int J Radiat Oncol Biol Phys. 1989 Aug;17(2):361-3. doi: 10.1016/0360-3016(89)90451-3.
The prognosis of patients with squamous cell carcinoma (SQC) of the head and neck (H&N) depends on the primary site and anatomical extent of the disease. Recurrence rates after conventional surgery (S) and/or radiotherapy (RT) remain low for localized tumors, whereas in advanced loco-regional disease they occur in over 60% of all cases. Several combinations of treatment modalities have been attempted in order to improve local control in Stages III and IV. Unfortunately, the recurrence rate remains high with added morbidity when conventional surgery is combined with pre or post-operative radiotherapy. Induction chemotherapy (CT) with Cisplatinum and Bleomycin has resulted in severe toxicities when combined with radiotherapy. To evaluate the toxicity of Carboplatin (CBDCA), a second generation platinum analog, when given simultaneously with conventional doses of radiotherapy, 26 patients with Stage IV SQC of the head and neck were treated at the University of Maryland Medical Systems. There were 23 males and 3 females; median age was 59 years and median Karnofski performance status was 60. Twenty patients had received no prior therapy; six had surgical exploration and excision with measurable residual disease. Anatomically, six patients had tumors of the oral cavity, twelve in the pharynx, one in the nasopharynx, four in the larynx, one in the hypopharynx, one in the maxillary antrum, and one was an unknown primary. These patients were treated as out-patients with weekly injections of Carboplatin. The dose was escalated: two patients received 60 mg/M2, seven received 75 mg/M2, thirteen were treated with 100 mg/M2, and four with 400 mg/M2. The radiotherapy was given daily with conventional fractions of 180 cGy and total tumor doses of 60-75 Gy. Toxicities were mainly hematological with median nadirs decreasing with increasing doses of Carboplatin. Mucositis was seen in over 80% of the patients, but interestingly enough, it has never been more severe than that observed with radiotherapy alone. So far, there has not been any kidney, ear, or neurotoxicities. Of 25 evaluable patients, 19 (76%) responded with 13 (52%) showing complete response. The overall median survival time is 266+ days (324+ for responders and 179+ for non-responders). The follow-up is still short, 10-14 months, but 9 of 13 patients with complete response have not yet progressed.
头颈部鳞状细胞癌（SQC）患者的预后取决于疾病的原发部位和解剖范围。对于局限性肿瘤，传统手术（S）和/或放疗（RT）后的复发率仍然较低，而在晚期局部区域疾病中，超过60%的病例会出现复发。为了提高III期和IV期的局部控制率，人们尝试了多种治疗方式的组合。不幸的是，当传统手术与术前或术后放疗联合使用时，复发率仍然很高，且并发症增加。顺铂和博来霉素诱导化疗（CT）与放疗联合使用时会产生严重毒性。为了评估第二代铂类类似物卡铂（CBDCA）与传统剂量放疗同时使用时的毒性，马里兰大学医学系统对26名头颈部IV期SQC患者进行了治疗。其中男性23例，女性3例；中位年龄为59岁，中位卡诺夫斯基表现状态为60。20例患者此前未接受过治疗；6例患者接受了手术探查和切除，有可测量的残留疾病。从解剖学上看，6例患者的肿瘤位于口腔，12例位于咽部，1例位于鼻咽部，4例位于喉部，1例位于下咽，1例位于上颌窦，1例原发部位不明。这些患者作为门诊患者接受每周一次的卡铂注射治疗。剂量逐步增加：2例患者接受60mg/M²，7例接受75mg/M²，13例接受100mg/M²，4例接受400mg/M²。放疗每天进行，常规分割剂量为180cGy，肿瘤总剂量为60 - 75Gy。毒性主要为血液学毒性，中位最低点随着卡铂剂量的增加而降低。超过80%的患者出现了粘膜炎，但有趣的是，其严重程度从未超过单纯放疗时观察到的情况。到目前为止，尚未出现任何肾脏、耳部或神经毒性。在25例可评估的患者中，19例（76%）有反应，其中13例（52%）显示完全缓解。总体中位生存时间为266 +天（有反应者为324 +天，无反应者为179 +天）。随访时间仍然较短，为10 - 14个月，但13例完全缓解的患者中有9例尚未进展。
