在调强放疗时代，70岁及以上口咽癌患者同步放化疗的毒性和疗效。
The toxicity and efficacy of concomitant chemoradiotherapy in patients aged 70 years and older with oropharyngeal carcinoma in the intensity-modulated radiotherapy era.
作者信息
Zumsteg Zachary S, Lok Benjamin H, Ho Allen S, Drill Esther, Zhang Zhigang, Riaz Nadeem, Shiao Stephen L, Ma Jennifer, McBride Sean M, Tsai C Jillian, Baxi Shrujal S, Sherman Eric J, Lee Nancy Y
机构信息
Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, California.
Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California.
出版信息
Cancer. 2017 Apr 15;123(8):1345-1353. doi: 10.1002/cncr.30495. Epub 2016 Dec 16.
BACKGROUND
Despite controversy surrounding its benefit, the use of concomitant chemoradiotherapy (CCRT) in patients with oropharyngeal squamous cell carcinoma (OPSCC) who are aged > 70 years is increasing. However, to the authors' knowledge, few studies to date have compared the outcomes of different systemic treatments in this population.
METHODS
Records from 74 patients aged ≥ 70 years with stage III to stage IVB OPSCC who were undergoing CCRT from 2002 to 2013 at a single institution were reviewed. Patients were stratified according to the systemic therapy received, including cisplatin, carboplatin with either 5-fluorouracil or paclitaxel (CARB), or cetuximab to compare oncologic outcome and toxicity.
RESULTS
The median follow-up was 36 months. The median age of the patients was 75.3 years (range, 70-91 years), with significantly older patients receiving cetuximab (P = .03). A total of 28, 20, and 26 patients, respectively, received CCRT with cisplatin, CARB, and cetuximab. RT interruptions of > 1 day were needed in 4% of patients receiving cisplatin, 20% of patients receiving CARB, and 15% of patients receiving cetuximab (P = .19). Unplanned hospitalizations during CCRT occurred in 25%, 55%, and 58%, respectively, of patients receiving cisplatin, CARB, and cetuximab (P = .03). There were 2 treatment-related deaths, both of which occurred among the patients who were treated with cetuximab. At 5 years, locoregional control was achieved in 100%, 88%, and 60% (P<.001), respectively, and the overall survival rate was 87%, 61%, and 47% (P = .03), respectively, among patients treated with cisplatin, CARB, and cetuximab.
CONCLUSIONS
Toxicity from CCRT remains a challenge for older adults with OPSCC. Herein, the authors found no evidence that this toxicity was mitigated by treatment with cetuximab. Nevertheless, a subset of patients aged ≥70 years appear to tolerate cisplatin-based treatment with acceptable toxicity and excellent outcomes. Further identification of this patient subgroup is crucial to optimize therapy for older patients with OPSCC. Cancer 2017;123:1345-1353. © 2016 American Cancer Society.
背景
尽管同步放化疗（CCRT）的益处存在争议，但在年龄大于70岁的口咽鳞状细胞癌（OPSCC）患者中，其使用仍在增加。然而，据作者所知，迄今为止很少有研究比较该人群中不同全身治疗的结果。
方法
回顾了2002年至2013年在单一机构接受CCRT的74例年龄≥70岁、分期为III期至IVB期的OPSCC患者的记录。根据接受的全身治疗将患者分层，包括顺铂、卡铂联合5-氟尿嘧啶或紫杉醇（CARB），或西妥昔单抗，以比较肿瘤学结局和毒性。
结果
中位随访时间为36个月。患者的中位年龄为75.3岁（范围70 - 91岁），接受西妥昔单抗治疗的患者年龄显著更大（P = 0.03）。分别有28例、20例和26例患者接受了顺铂、CARB和西妥昔单抗的CCRT。接受顺铂治疗的患者中有4%、接受CARB治疗的患者中有20%、接受西妥昔单抗治疗的患者中有15%需要放疗中断超过1天（P = 0.19）。CCRT期间计划外住院分别发生在接受顺铂、CARB和西妥昔单抗治疗的患者中的25%、55%和58%（P = 0.03）。有2例与治疗相关的死亡，均发生在接受西妥昔单抗治疗的患者中。在5年时，接受顺铂、CARB和西妥昔单抗治疗的患者局部区域控制率分别为100%、88%和60%（P<0.001），总生存率分别为87%、61%和47%（P = 0.03）。
结论
CCRT的毒性对老年OPSCC患者仍然是一个挑战。在此，作者未发现证据表明西妥昔单抗治疗可减轻这种毒性。尽管如此，一部分年龄≥70岁的患者似乎能够耐受基于顺铂的治疗，毒性可接受且结局良好。进一步识别这一患者亚组对于优化老年OPSCC患者的治疗至关重要。《癌症》2017年；123：1345 - 1353。©2016美国癌症协会。
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