Al-Mamgani A, de Ridder M, Navran A, Klop W M, de Boer J P, Tesselaar M E
Department of Radiation Oncology, Netherlands Cancer Institute/Antoni van Leeuwenhoek, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.
Department of Radiation Oncology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
Eur Arch Otorhinolaryngol. 2017 Oct;274(10):3757-3765. doi: 10.1007/s00405-017-4687-4. Epub 2017 Jul 28.
Despite the wide use of cisplatin-based concomitant chemoradiotherapy (CCRT) for head and neck squamous cell carcinoma (HNSCC), data on the optimal regimen and cumulative dose are scarce and frequently conflicting. We aimed to evaluate the compliance and the impact of the cumulative dose of cisplatin on overall survival (OS), disease-free survival (DFS), loco-regional control (LRC), and distant-metastasis-free survival (DMFS) in a retrospective study. Between 2008 and 2015, 279 patients with HNSCC scheduled for CCRT (three courses of 3-week 100 mg/m cisplatin) were identified. Of the whole group, 14% did not receive any cisplatin and 26% received daily cisplatin. In patients planned for three courses (n = 167), 56% received 3, 20% received 2, and 24% received one course. After median follow-up of 31.6 months, the actuarial OS, DFS, LRC, and DMFS rates at 3 years for patients received cumulative dose of ≥200 mg/m were significantly better compared to those received <200 mg/m; 74 vs. 51% for OS, 73 vs. 49% for DFS, 80 vs. 58% for LRC (p < 0.001), and 85 vs. 76% for DMFS (p = 0.034). At multivariate analysis, the cumulative cisplatin dose (≥200 vs. <200 mg/m) was significantly predictive for OS (HR 2.05; 95% CI 1.35-3.13, p = <0.001). Borderline GFR (60-70 mL/min) at baseline predicts compliance for ≥two courses (p = 0.003). In conclusion, considerable proportion of patients did not receive all pre-planned courses of cisplatin. Patients receiving cumulative cisplatin dose ≥200 mg/m had significantly better outcome than those receiving <200 mg/m and cumulative dose <200 mg/m might even be detrimental. These findings increased the bulk of slowly growing evidence on the optimal cumulative dose of cisplatin. Baseline GFR might predict compliance.
尽管基于顺铂的同步放化疗（CCRT）在头颈部鳞状细胞癌（HNSCC）中广泛应用，但关于最佳方案和累积剂量的数据稀缺且常常相互矛盾。我们旨在通过一项回顾性研究评估顺铂累积剂量的依从性及其对总生存期（OS）、无病生存期（DFS）、局部区域控制（LRC）和无远处转移生存期（DMFS）的影响。2008年至2015年期间，确定了279例计划接受CCRT（三个疗程，每3周100mg/m²顺铂）的HNSCC患者。在整个组中，14%未接受任何顺铂，26%接受每日顺铂。在计划接受三个疗程的患者（n = 167）中，56%接受了3个疗程，20%接受了2个疗程，24%接受了1个疗程。中位随访31.6个月后，累积剂量≥200mg/m²的患者3年的精算OS、DFS、LRC和DMFS率显著优于累积剂量<200mg/m²的患者；OS分别为74% vs. 51%，DFS分别为73% vs. 49%，LRC分别为80% vs. 58%（p < 0.001），DMFS分别为85% vs. 76%（p = 0.034）。多因素分析时，顺铂累积剂量（≥200 vs. <200mg/m²）对OS有显著预测价值（HR 2.05；95%CI 1.35 - 3.13，p = <0.001）。基线时临界肾小球滤过率（GFR，60 - 70mL/min）可预测≥两个疗程的依从性（p = 0.003）。总之，相当比例的患者未接受所有预先计划的顺铂疗程。累积顺铂剂量≥200mg/m²的患者结局显著优于累积剂量<200mg/m²的患者，累积剂量<200mg/m²甚至可能有害。这些发现增加了关于顺铂最佳累积剂量的缓慢增长的证据量。基线GFR可能预测依从性。
