Department of Otorhinolaryngology, Head and Neck Surgery, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachioji-shi, Tokyo, 193-0998, Japan.
Department of Otorhinolaryngology, Head and Neck Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan.
Eur Arch Otorhinolaryngol. 2021 Sep;278(9):3497-3506. doi: 10.1007/s00405-020-06549-9. Epub 2021 Jan 2.
The standard induction chemotherapy for head and neck cancer is TPF [cisplatin (CDDP), docetaxel (DOC), and 5-fluorouracil (5-FU)]. We assessed whether one course of TPF could predict the efficacy of chemoradiotherapy for human papilloma virus (HPV)-related oropharyngeal squamous cell carcinoma.
We retrospectively reviewed 51 patients with stage III-IV HPV-related oropharyngeal squamous cell carcinoma who received one course of TPF with CDDP 60 mg/m, DOC 60 mg/m, and 5-FU 600 mg/m. We recommended chemoradiotherapy for patients with complete or partial response (CR/PR), and surgery for those with stable or progressive disease (SD/PD). The endpoints were TPF-related adverse events and efficacy, chemoradiotherapy efficacy, and 2-year survival.
Neutropenia was the most common grade ≥ 3 adverse event (88%). No grade 5 adverse events occurred. TPF achieved CR in 4% of patients (2/51), PR in 73% (37/51), SD in 20% (10/51), and PD in 4% (2/51). Concurrent cetuximab and radiotherapy (bio-radiotherapy, BRT) were administered to 61% of patients (31/51), concurrent CDDP and radiotherapy (CDDP-RT) to 16% (8/51), RT alone to 2% (1/51), and surgery was performed for 22% (11/51). CR was achieved in 85% of the chemoradiotherapy group, and the rate tended to increase with TPF efficacy. CR was achieved in 84% (26/31) of patients receiving BRT, 88% (7/8) receiving CDDP-RT, and 100% (1/1) receiving RT. The 2-year survival rates were 92% overall, and 97% and 79% in the chemoradiotherapy and surgery groups, respectively.
When facing difficulty in deciding between chemoradiotherapy and surgery, one course of TPF may be an effective option.
头颈部癌症的标准诱导化疗是 TPF [顺铂（CDDP）、多西他赛（DOC）和 5-氟尿嘧啶（5-FU）]。我们评估了一个疗程的 TPF 是否可以预测人乳头瘤病毒（HPV）相关口咽鳞状细胞癌的放化疗疗效。
我们回顾性分析了 51 例接受 TPF（CDDP 60mg/m、DOC 60mg/m 和 5-FU 600mg/m）一个疗程的 III-IV 期 HPV 相关口咽鳞状细胞癌患者。我们建议对完全或部分缓解（CR/PR）的患者进行放化疗，对稳定或进展性疾病（SD/PD）的患者进行手术。终点是 TPF 相关不良事件和疗效、放化疗疗效和 2 年生存率。
中性粒细胞减少是最常见的≥3 级不良事件（88%）。无 5 级不良事件发生。TPF 治疗的患者中，CR 为 4%（2/51），PR 为 73%（37/51），SD 为 20%（10/51），PD 为 4%（2/51）。61%（31/51）的患者接受顺铂联合放疗（生物放疗，BRT），16%（8/51）的患者接受顺铂联合放疗（CDDP-RT），2%（1/51）的患者接受单纯放疗，22%（11/51）的患者接受手术。放化疗组 CR 率为 85%，且随着 TPF 疗效的提高，CR 率呈上升趋势。BRT 组 CR 率为 84%（26/31），CDDP-RT 组为 88%（7/8），RT 组为 100%（1/1）。总 2 年生存率为 92%，放化疗组为 97%，手术组为 79%。
在决定放化疗与手术之间存在困难时，一个疗程的 TPF 可能是一种有效的选择。
