Porceddu Sandro V, Scotté Florian, Aapro Matti, Salmio Satu, Castro Ana, Launay-Vacher Vincent, Licitra Lisa
University of Queensland, Princess Alexandra Hospital, Woolloongabba, QLD, Australia.
Department of Medical Oncology and Supportive Care, Hôpital Foch, Suresnes, France.
Front Oncol. 2020 Jan 22;9:1522. doi: 10.3389/fonc.2019.01522. eCollection 2019.
Concurrent chemoradiotherapy with high-dose cisplatin (100 mg/m every 3 weeks) is the preferred regimen with curative intent for patients with unresected locally advanced squamous cell carcinoma of the head and neck (LA SCCHN). This treatment is associated with acute and late toxicities, including myelosuppression, severe nausea/vomiting, irreversible renal failure, hearing loss, and neurotoxicity. Because of cisplatin's safety profile, treatment adherence to high-dose cisplatin can be suboptimal. Patients commonly receive less than the total cumulative target dose of 300 mg/m or the minimum recommended dose of 200 mg/m, which can have a negative impact on locoregional control and survival. Alternatively, cetuximab plus radiotherapy may be most suitable for patients at high risk of non-adherence to high-dose cisplatin. We discuss the baseline characteristics dictating the unsuitability/borderline unsuitability of cisplatin and the available alternative evidence-based treatment regimens for patients with LA SCCHN. We non-systematically reviewed published phase II and III trials and retrospective analyses of high-dose cisplatin-based chemoradiation in LA SCCHN conducted between 1987 and 2018, focusing on recent key phase III studies. We defined the baseline characteristics and associated prescreening tests to determine unsuitability and borderline unsuitability for high-dose cisplatin in combination with radiotherapy in patients with LA SCCHN. Patients with any pre-existing comorbidities that may be exacerbated by high-dose cisplatin treatment can be redirected to a non-cisplatin-based option to minimize the risk of treatment non-adherence. High-dose cisplatin plus radiotherapy remains the preferred treatment for fit patients with unresected LA SCCHN; patients who are unsuitable or borderline unsuitable for high-dose cisplatin could be identified using available tests for potential comorbidities and should be offered alternative treatments, such as cetuximab plus radiotherapy.
对于无法切除的局部晚期头颈部鳞状细胞癌（LA SCCHN）患者，采用高剂量顺铂（每3周100 mg/m²）同步放化疗是具有治愈意图的首选方案。这种治疗会带来急性和晚期毒性，包括骨髓抑制、严重恶心/呕吐、不可逆肾衰竭、听力丧失和神经毒性。由于顺铂的安全性，高剂量顺铂治疗的依从性可能不理想。患者通常接受的累积总目标剂量低于300 mg/m²或最低推荐剂量200 mg/m²，这可能对局部区域控制和生存产生负面影响。另外，西妥昔单抗联合放疗可能最适合高剂量顺铂治疗依从性差风险高的患者。我们讨论了决定顺铂不适用/临界不适用的基线特征以及LA SCCHN患者可用的基于证据的替代治疗方案。我们非系统地回顾了1987年至2018年间发表的关于LA SCCHN中基于高剂量顺铂的放化疗的II期和III期试验以及回顾性分析，重点关注近期关键的III期研究。我们定义了基线特征和相关的预筛查测试，以确定LA SCCHN患者中高剂量顺铂联合放疗的不适用性和临界不适用性。任何可能因高剂量顺铂治疗而加重的现有合并症患者可转向基于非顺铂的方案，以尽量降低治疗不依从的风险。高剂量顺铂联合放疗仍然是适合的无法切除的LA SCCHN患者的首选治疗方法；对于高剂量顺铂不适用或临界不适用的患者，可以使用针对潜在合并症的现有测试进行识别，并应提供替代治疗，如西妥昔单抗联合放疗。
