Mishra Bal Krishna, Kapoor Akhil, Gupta Anuj, Sansar Bipinesh, Singh Arpita, Roy Somnath, Mandal Tanmoy, Srinivas Sujay, Das Sudeep, Mishra Aseem, Mukherjee Ashutosh, Nanda Sambit, Sambasivaiah Kurupathy
Department of Medical Oncology, Mahamana Pandit Madan Mohan Malviya Cancer Centre & Homi Bhabha Cancer Hospital, Tata Memorial Centre, Varanasi, 221005, India.
Department of Head and Neck Surgery, Mahamana Pandit Madan Mohan Malviya Cancer Centre & Homi Bhabha Cancer Hospital, Tata Memorial Centre, Varanasi, 221005, India.
Ecancermedicalscience. 2022 Nov 2;16:1460. doi: 10.3332/ecancer.2022.1460. eCollection 2022.
The data regarding the use of neoadjuvant chemotherapy in technically unresectable head and neck cancer (HNC) is limited and real-world studies are needed to look for the efficacy and toxicities of this approach.
This is a retrospective study conducted in the Medical Oncology department of our hospital. All technically unresectable HNC patients who underwent neoadjuvant chemotherapy between May 2018 and May 2020 were included in this analysis. Patients received three-drug regimen docetaxel, cisplatin and 5-fluorouracil (DCF) regimen, two-drug regimens included docetaxel + cisplatin, paclitaxel + carboplatin both weekly and 3-weekly. The resectability assessment was done clinically and radiologically after completing three neoadjuvant cycles. Overall survival was calculated from the first day of chemotherapy to the date of last follow-up or date of death.
A total of 119 patients received neoadjuvant chemotherapy during the specified time. Response assessment showed partial response in 41.9% of patients with three-drug regimens and 37.5% of patients with other regimens. Out of 119 patients, 56 (47%) patients were offered radical intent therapy. Resectability was achieved in 32.3% of three-drug regimen patients and 26.1% of other patients. Surgery was feasible in 33 (27.7%) patients, and postoperative radiotherapy and concurrent chemotherapy were done in 30 patients (25.2%), and surgery with only postoperative radiotherapy was done in 3 patients (2.5%). Radical chemoradiotherapy was done in 23 patients (19.3%). The estimated median survival for patients who could undergo surgery was 18 months [95% confidence interval (CI), 14.9-21.0], and nonsurgical patients were 9 months (95% CI, 7.3-10.6) (p = 0.0001).
Our study shows that neoadjuvant chemotherapy in technically unresectable HNC patients can make the disease resectable in around one-third of the patients. The patients who could undergo surgery after neoadjuvant chemotherapy had significantly improved survival as compared to those who could not.
关于在技术上不可切除的头颈癌（HNC）中使用新辅助化疗的数据有限，需要进行真实世界研究来探寻这种治疗方法的疗效和毒性。
这是一项在我院肿瘤内科进行的回顾性研究。纳入了2018年5月至2020年5月期间接受新辅助化疗的所有技术上不可切除的HNC患者。患者接受三药方案多西他赛、顺铂和5-氟尿嘧啶（DCF）方案，两药方案包括多西他赛+顺铂、紫杉醇+卡铂，均为每周和每3周一次。在完成三个新辅助周期后进行临床和影像学的可切除性评估。总生存期从化疗第一天计算至最后一次随访日期或死亡日期。
在指定时间内共有119例患者接受了新辅助化疗。疗效评估显示，三药方案患者中有41.9%部分缓解，其他方案患者中有37.5%部分缓解。在119例患者中，56例（47%）患者接受了根治性意向治疗。三药方案患者中有32.3%实现了可切除性，其他患者中有26.1%实现了可切除性。33例（27.7%）患者可行手术，30例患者（25.2%）进行了术后放疗和同步化疗，3例患者（2.5%）仅进行了术后放疗。23例患者（19.3%）进行了根治性放化疗。可进行手术的患者估计中位生存期为18个月[95%置信区间（CI），14.9 - 21.0]，不可手术患者为9个月（95% CI，7.3 - 10.6）（p = 0.0001）。
我们的研究表明，在技术上不可切除的HNC患者中，新辅助化疗可使约三分之一的患者疾病变得可切除。与无法进行手术的患者相比，新辅助化疗后可进行手术的患者生存期显著改善。
