Hanemaaijer Saskia H, Kok Iris C, Fehrmann Rudolf S N, van der Vegt Bert, Gietema Jourik A, Plaat Boudewijn E C, van Vugt Marcel A T M, Vergeer Marije R, Leemans C René, Langendijk Johannes A, Voortman Jens, Buter Jan, Oosting Sjoukje F
Department of Otorhinolaryngology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands.
Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands.
Front Oncol. 2020 Jun 5;10:761. doi: 10.3389/fonc.2020.00761. eCollection 2020.
Chemoradiotherapy (CRT) including three cycles of cisplatin is considered the standard of care for locally advanced head and neck squamous cell carcinoma (LA-HNSCC). However, around one-third of the patients cannot complete cisplatin because of toxicity. Carboplatin plus 5-fluorouracil (carbo-5FU) is another accepted treatment option with a different toxicity profile. We compared tolerability and efficacy of concomitant carbo-5FU and cisplatin. We conducted a retrospective analysis of LA-HNSCC patients treated with CRT in two Dutch cancer centers between 2007 and 2016. All patients received intensity-modulated radiotherapy. One center routinely administered carboplatin 300-350 mg/m at day 1, 22, and 43 followed by 5FU 600 mg/m/day for 96 h. The other center used cisplatin 100 mg/m at day 1, 22, and 43. The primary endpoint of this study was chemotherapy completion rate. Secondary endpoints included overall survival (OS), disease-free survival (DFS), locoregional control (LRC) and distant metastasis-free interval (DMFS), toxicity, and unplanned admissions. In the carbo-5FU cohort ( = 211), 60.2% of the patients completed chemotherapy vs. 76.7% ( < 0.001) of the patients in the cisplatin cohort ( = 223). Univariate analysis showed a higher risk of death in the carbo-5FU cohort [hazard ratio (HR) 1.53, 95% CI, 1.09-2.14, = 0.01] with a 3-year OS of 65.4 vs. 76.5% for cisplatin. OS was independently associated with T and N stage and p16 status, but not with chemotherapy regimen (HR 1.08, 95% CI, 0.76-1.55, = 0.65). Three-year DFS was 70.0% for carbo-5FU vs. 78.6% for cisplatin (HR 1.37, 95% CI, 0.93-2.01, = 0.05). A similar outcome was observed for both LRC (HR 1.27, 95% CI, 0.74-2.09, = 0.4) and DMFS (HR 1.08, 95% CI 0.62-1.90, = 0.77). The risk of discontinuation for chemotherapy-associated toxicity was higher in the carbo-5FU cohort than in the cisplatin cohort (relative risk = 1.69). LA-HNSCC patients treated with concomitant carbo-5FU completed chemotherapy less frequently than patients treated with cisplatin. Treatment regimen was not an independent prognostic factor for OS.
包括三个顺铂周期的同步放化疗（CRT）被认为是局部晚期头颈部鳞状细胞癌（LA-HNSCC）的标准治疗方案。然而，约三分之一的患者因毒性反应无法完成顺铂治疗。卡铂联合5-氟尿嘧啶（卡铂-5FU）是另一种被认可的治疗选择，其毒性特征不同。我们比较了同步卡铂-5FU和顺铂的耐受性和疗效。我们对2007年至2016年期间在荷兰两个癌症中心接受CRT治疗的LA-HNSCC患者进行了回顾性分析。所有患者均接受调强放疗。一个中心在第1天、第22天和第43天常规给予卡铂300-350mg/m²，随后给予5FU 600mg/m²/天，持续96小时。另一个中心在第1天、第22天和第43天使用顺铂100mg/m²。本研究的主要终点是化疗完成率。次要终点包括总生存期（OS）、无病生存期（DFS）、局部区域控制（LRC）和无远处转移生存期（DMFS）、毒性反应以及非计划住院情况。在卡铂-5FU队列（n = 211）中，60.2%的患者完成了化疗，而顺铂队列（n = 223）中这一比例为76.7%（P < 0.001）。单因素分析显示，卡铂-5FU队列的死亡风险更高[风险比（HR）1.53，95%置信区间，1.09-2.14，P = 0.01]，卡铂-5FU组的3年总生存率为65.4%，而顺铂组为76.5%。总生存期与T和N分期以及p16状态独立相关，但与化疗方案无关（HR 1.08，95%置信区间，0.76-1.55，P = 0.65）。卡铂-5FU组的3年无病生存率为70.0%，顺铂组为78.6%（HR 1.37，95%置信区间，0.93-2.01，P = 0.05）。局部区域控制（HR 1.27，95%置信区间，0.74-2.09，P = 0.4）和无远处转移生存期（HR 1.08，95%置信区间0.62-1.90，P = 0.77）也观察到了类似结果。卡铂-5FU队列中因化疗相关毒性而停药的风险高于顺铂队列（相对风险 = 1.69）。接受同步卡铂-5FU治疗的LA-HNSCC患者完成化疗的频率低于接受顺铂治疗的患者。治疗方案不是总生存期的独立预后因素。
