Wheeler R, Salter M, Stephens S, Hardy I, Peters G, Urist M, Maddox W
Department of Medicine, University of Alabama, Birmingham 35294.
NCI Monogr. 1988(6):339-41.
Studies using simultaneous radiation therapy and conventional doses of cisplatin have suggested improvement in local control and patient survival. This study was undertaken to determine toxicity and patient tolerance to concomitant high-dose cisplatin (40 mg/m2 per day X 5) and radiation (60 Gy in 6 wk +/- 10-Gy boost to residual tumor). Seventeen patients with advanced, inoperable squamous cell cancer primary tumor in the head and neck were treated (15 males and 2 females; median age, 57 yr). Cisplatin was started on day 1 of radiation therapy and repeated every 28 days for three cycles. Normal saline infusion (250 ml/hr) was started 12 hours prior to the first dose and continued 12 hours after the fifth dose. The daily dose of cisplatin was dissolved in 250 ml of 3% NaCl and given over 30 minutes. The cisplatin dose for subsequent cycles was reduced 10 mg/m2 per day only for a nadir granulocyte count less than 500/mm3 or fever greater than 101 degrees F during leukopenia. Of the 17 patients who started therapy, 15 have completed therapy; 1 patient died after one cycle, and 1 died after two cycles. Eleven patients received three cycles of cisplatin, and 10 patients required one dose reduction (6 at course 2 and 4 at course 3). Seven possible infections were successfully treated. Grade 2 neuropathy occurred in 3 patients, and renal toxicity greater than grade 1 occurred in 1 patient. Additional toxic effects were median WBC count nadir of 1.8 X 10(3)/mm3, platelet count nadir of 128 X 10(3)/mm3, hemoglobin nadir of 9.8 g/dl, and median weight loss of 5%.(ABSTRACT TRUNCATED AT 250 WORDS)
采用同步放射治疗和常规剂量顺铂的研究表明，局部控制和患者生存率有所提高。本研究旨在确定患者对大剂量顺铂（每天40mg/m²，共5天）与放疗（6周内60Gy，对残留肿瘤追加10Gy）联合治疗的毒性和耐受性。对17例晚期、无法手术的头颈部原发性鳞状细胞癌患者进行了治疗（15例男性，2例女性；中位年龄57岁）。顺铂在放疗第1天开始使用，每28天重复一次，共三个周期。在首次给药前12小时开始输注生理盐水（250ml/小时），并在第五次给药后持续12小时。每日顺铂剂量溶解于250ml 3%氯化钠中，30分钟内输注完毕。仅当中性粒细胞计数最低点低于500/mm³或白细胞减少期间发热超过101华氏度时，后续周期的顺铂剂量每天减少10mg/m²。在开始治疗的17例患者中，15例完成了治疗；1例在一个周期后死亡，1例在两个周期后死亡。11例患者接受了三个周期的顺铂治疗，10例患者需要减少一次剂量（第2疗程6例，第3疗程4例）。7例可能的感染得到成功治疗。3例患者出现2级神经病变，1例患者出现大于1级的肾毒性。其他毒性反应包括白细胞计数最低点中位数为1.8×10³/mm³、血小板计数最低点为128×10³/mm³、血红蛋白最低点为9.8g/dl以及体重减轻中位数为5%。（摘要截断于250字）
