Nakashima Torahiko, Yasumatsu Ryuji, Asai Kaori, Uryu Hideoki, Kogo Ryunosuke, Nakagawa Takashi
Department of Otorhinolaryngology, National Kyushu Medical Center, 1-8-1 Jigyohama, Chuo-ku, Fukuoka, 810-8563, Japan.
Department of Otorhinolaryngology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Int J Clin Oncol. 2017 Jun;22(3):442-447. doi: 10.1007/s10147-016-1084-8. Epub 2017 Jan 6.
The role of induction chemotherapy (IC) in the treatment of resectable advanced head and neck squamous cell carcinoma has not been elucidated, and the most effective IC regimen for chemoselection is still unknown. At our institute we have not used the triple combination of docetaxel, cisplatin, fluorouracil (TPF) for chemoselection, but rather the double combination of docetaxel + cisplatin (TP). The aim of this study is to report the outcome of patients with advanced hypopharyngeal cancer treated by single cycle of IC with TP followed by chemoradiation (CRT) or surgery.
A total of 29 patients with resectable advanced hypopharyngeal cancer who were treated with a single cycle of IC were entered into the study. Responders were treated by CRT while nonresponders underwent surgery. Outcomes were analyzed using the Kaplan-Meier method.
A single cycle of IC with TP achieved response in 21 of the 29 patients. The major side effect was neutropenia which could be managed without delaying the sequential treatment. The 2-year overall survival and disease-specific survival were both 74.0% (stage III 100%, stage IVA 69.1%). The cumulative 2-year laryngeal preservation rate was 100% for stage III and 53.6% for stage IVA.
A single cycle of IC with the combination of docetaxel + cisplatin may be sufficient to select advanced hypopharyngeal cancer patients with radio-sensitivity. IC intended for organ preservation strategies should be low toxic. Our strategy may be a useful for providing the benefits of IC and the opportunity for curative surgery without delay.
诱导化疗（IC）在可切除的晚期头颈部鳞状细胞癌治疗中的作用尚未阐明，且用于化疗选择的最有效IC方案仍不明确。在我们研究所，我们未使用多西他赛、顺铂、氟尿嘧啶三联组合（TPF）进行化疗选择，而是采用多西他赛+顺铂双联组合（TP）。本研究旨在报告接受单周期TP诱导化疗后序贯放化疗（CRT）或手术治疗的晚期下咽癌患者的治疗结果。
共有29例接受单周期IC治疗的可切除晚期下咽癌患者纳入本研究。有反应者接受CRT治疗，无反应者接受手术治疗。采用Kaplan-Meier法分析结果。
29例患者中，单周期TP诱导化疗有21例有反应。主要副作用是中性粒细胞减少，可在不延迟后续治疗的情况下进行处理。2年总生存率和疾病特异性生存率均为74.0%（Ⅲ期为100%，ⅣA期为69.1%）。Ⅲ期患者2年累计喉保留率为100%，ⅣA期为53.6%。
多西他赛+顺铂联合的单周期诱导化疗可能足以筛选出对放疗敏感的晚期下咽癌患者。旨在保留器官策略的诱导化疗应毒性低。我们的策略可能有助于在不延迟的情况下提供诱导化疗的益处以及进行根治性手术的机会。
