Forastiere A A
Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD.
Semin Oncol. 1994 Oct;21(5 Suppl 12):20-7.
Platinum-based chemotherapy has been used to treat head and neck cancer for approximately 15 years. For patients with recurrent disease, cisplatin/5-fluorouracil (5-FU) and carboplatin/5-FU combinations have proved superior to single agents in producing higher overall response rates. However, survival rates are not substantially affected, indicating a need to identify alternative new agents with activity. Newly diagnosed patients with advanced stages III and IV disease generally have a poor prognosis. The most common site of failure and cause of death is locoregional recurrence. To improve survival and alter patterns of failure in this population, platinum-based chemotherapy regimens have been combined with surgery or radiotherapy as initial curative treatment. Cisplatin/5-FU chemotherapy in this setting is effective in significantly reducing the incidence of distant metastases as shown in several randomized trials. The sole indication for induction chemotherapy in patients with advanced laryngeal cancer is as an alternative to laryngectomy. The Department of Veterans Affairs Laryngeal Cancer Study Group trial demonstrated no significant differences in survival in patients who received induction cisplatin/5-FU and radiotherapy or total laryngectomy and postoperative radiotherapy. An alternative approach utilizing cisplatin or carboplatin alone or combined with 5-FU, administered simultaneously with radiotherapy, is under investigation. Pilot data suggest that this approach may be more effective in improving locoregional control and hence survival. Three intergroup prospective, randomized trials currently are comparing sequential chemoradiotherapy, simultaneous chemoradiotherapy, and standard radiotherapy alone in advanced nasopharyngeal cancer, advanced resectable laryngeal cancer, and unresectable cancers from other sites in the head and neck. These trials are designed to definitively address questions of treatment modality sequence and its impact on pattern of failure and survival.
铂类化疗已用于治疗头颈癌约15年。对于复发性疾病患者，顺铂/5-氟尿嘧啶（5-FU）和卡铂/5-FU联合用药已被证明在产生更高的总体缓解率方面优于单药治疗。然而，生存率并未受到实质性影响，这表明需要确定具有活性的替代新药。新诊断的III期和IV期晚期患者通常预后较差。最常见的失败部位和死亡原因是局部区域复发。为了提高这一人群的生存率并改变失败模式，铂类化疗方案已与手术或放疗联合作为初始根治性治疗。在这种情况下，顺铂/5-FU化疗在显著降低远处转移发生率方面是有效的，这在几项随机试验中得到了证实。晚期喉癌患者诱导化疗的唯一指征是作为喉切除术的替代方案。退伍军人事务部喉癌研究组的试验表明，接受诱导顺铂/5-FU和放疗或全喉切除术及术后放疗的患者在生存率上没有显著差异。一种替代方法是单独使用顺铂或卡铂或与5-FU联合，与放疗同时进行，目前正在研究中。初步数据表明，这种方法可能在改善局部区域控制从而提高生存率方面更有效。目前有三项组间前瞻性随机试验正在比较晚期鼻咽癌、晚期可切除喉癌以及头颈部其他部位不可切除癌症的序贯放化疗、同步放化疗和单纯标准放疗。这些试验旨在明确解决治疗方式顺序及其对失败模式和生存率影响的问题。
