Szturz Petr, Cristina Valerie, Herrera Gómez Ruth Gabriela, Bourhis Jean, Simon Christian, Vermorken Jan B
Medical Oncology, Department of Oncology, Lausanne University Hospital (CHUV), Lausanne, Switzerland.
Radiation Oncology, Department of Oncology, Lausanne University Hospital (CHUV), Lausanne, Switzerland.
Front Oncol. 2019 Jun 11;9:464. doi: 10.3389/fonc.2019.00464. eCollection 2019.
Well-designed randomized trials provide the highest level of scientific evidence to guide clinical decision making. In chemoradiotherapy of locally advanced squamous cell carcinoma of the head and neck (SCCHN), data support the use of three cycles of 100 mg/m cisplatin given every 3 weeks concurrently with conventionally fractionated external beam radiotherapy, although a full compliance with all three cycles is reserved to only about two thirds of initially eligible cases. On an individual patient level, practicing oncologists have to determine whether the patient is a suitable candidate for this treatment or whether contraindications exist. In the latter case, an adequate alternative has to be offered. In this regard, to facilitate triaging of medical information, we reviewed available publications on this topic and prepared practice-oriented recommendations for systemic treatment concurrent to definitive and post-operative radiotherapy. Even if no contraindications for the standard-of-care cisplatin apply, clinicians may opt for alternative regimens by adjusting the peak dose, cumulative dose, or timing of cisplatin. Relative contraindications pose the major issue in clinical practice, as very limited data is available in the literature and final decisions are usually based on an expert opinion or retrospective cohort studies. In the case of absolute interdiction of cisplatin, several alternative regimens incorporating carboplatin, 5-fluorouracil, cetuximab, and docetaxel are available. At the same time, it should be kept in mind that radiotherapy alone represents a viable option with hyperfractionation being particularly beneficial in the definitive management of limited nodal disease. Ideally, all treatment propositions should be discussed within multidisciplinary tumor boards taking into account the patient- and disease-related characteristics as well as local logistics and reimbursement policies.
设计良好的随机试验为指导临床决策提供了最高水平的科学证据。在局部晚期头颈部鳞状细胞癌（SCCHN）的放化疗中，数据支持每3周给予100mg/m²顺铂，共三个周期，同时进行常规分割的外照射放疗，尽管最初符合条件的病例中只有约三分之二能完全完成三个周期的治疗。在个体患者层面，执业肿瘤学家必须确定患者是否适合这种治疗，或者是否存在禁忌症。在后一种情况下，必须提供适当的替代方案。在这方面，为便于对医学信息进行分类，我们回顾了关于该主题的现有出版物，并制定了针对确定性放疗和术后放疗同时进行的全身治疗的实用建议。即使标准治疗顺铂没有禁忌症，临床医生也可以通过调整顺铂的峰值剂量、累积剂量或给药时间来选择替代方案。相对禁忌症是临床实践中的主要问题，因为文献中的数据非常有限，最终决策通常基于专家意见或回顾性队列研究。在绝对禁用顺铂的情况下，可以采用几种包含卡铂、5-氟尿嘧啶、西妥昔单抗和多西他赛的替代方案。同时，应记住单纯放疗也是一种可行的选择，超分割放疗在局限性淋巴结疾病的确定性治疗中尤其有益。理想情况下，所有治疗方案都应在多学科肿瘤委员会中进行讨论，同时考虑患者和疾病相关特征以及当地的后勤和报销政策。
