Wittes R, Heller K, Randolph V, Howard J, Vallejo A, Farr H, Harrold C, Gerold F, Shah J, Spiro R, Strong E
Cancer Treat Rep. 1979 Sep-Oct;63(9-10):1533-8.
During the past 2--3 years, a total of 73 patients with advanced head and neck cancer (mostly stage IV) were treated with cis-dichlorodiammineplatinum(II) (cis-platinum) as initial therapy, either alone or in combination with other agents. After chemotherapy, the patients received surgery and/or radiation therapy in standard fashion. Major degrees of tumor regression were seen in 40%--71% of the patients. cis-Platinum and bleomycin given by infusion gave the highest response rate (71%). The addition of high-dose methotrexate to cis-platinum plus bleomycin produced an unacceptable level of toxicity. Similarly, a four-drug regimen in which low-dose methotrexate and vinblastine were added to cis-platinum and bleomycin resulted in increased toxicity without additional therapeutic effect. Initial chemotherapy does not compromise subsequent surgery or increase either the immediate complications of surgery or the acute toxicity of radiation therapy. It seems unlikely that initial chemotherapy has altered the grim prognosis of an advanced, inoperable presentation. The effect of initial chemotherapy on advanced, operable disease will have to be assessed by suitable controlled trials.
在过去两到三年间，共有73例晚期头颈癌患者（大多为IV期）接受了顺二氯二氨铂（顺铂）作为初始治疗，治疗方式为单独使用或与其他药物联合使用。化疗后，患者接受标准方式的手术和/或放射治疗。40%至71%的患者出现了显著程度的肿瘤消退。通过静脉输注给予顺铂和博来霉素的缓解率最高（71%）。在顺铂加博来霉素方案中加入高剂量甲氨蝶呤会产生无法接受的毒性水平。同样，在顺铂和博来霉素方案中加入低剂量甲氨蝶呤和长春花碱的四联方案导致毒性增加，且无额外治疗效果。初始化疗不会影响后续手术，也不会增加手术的即刻并发症或放射治疗的急性毒性。初始化疗似乎不太可能改变晚期、无法手术患者的严峻预后。初始化疗对晚期可手术疾病的影响必须通过适当的对照试验来评估。
