Stupp R, Vokes E E
University of Chicago Medical Center, Ill, USA.
Strahlenther Onkol. 1995 Mar;171(3):140-8.
Local recurrences are one of the main reasons of failure of therapy for locally advanced cancer of the head and neck. Concomitant chemoradiotherapy and accelerated radiation techniques are supposed to improve the locoregional control rates.
We review the theoretical background and the most important larger clinical trials using concomitant or alternating chemoradiotherapy. The data of alternative fractionation schedules are also briefly reviewed.
For many chemotherapy agents a radiosensitizing effect has been shown. Significantly improved locoregional control has been shown for mitomycin C, cisplatin and 5-fluorouracil. Most studies failed to show improved survival. The major factor for this negative result is the common multimorbidity of patients leading to death of other causes then cancer.
Concomitant, alternating or split course chemoradiotherapy can improve locoregional control. Improved survival has been shown rarely. Confirmatory studies are necessary before adapting this approach in daily practice outside clinical trials. Accelerated hyperfractionation with or without chemotherapy may further improve the control rates. Reirradiation with concomitant chemotherapy in recurrent tumors achieves complete response rates of over 40%.
局部复发是局部晚期头颈癌治疗失败的主要原因之一。同步放化疗和加速放疗技术有望提高局部区域控制率。
我们回顾了使用同步或交替放化疗的理论背景及最重要的大型临床试验。也简要回顾了交替分割方案的数据。
已显示多种化疗药物具有放射增敏作用。丝裂霉素C、顺铂和5-氟尿嘧啶已显示出显著改善的局部区域控制。大多数研究未能显示生存率提高。这一负面结果的主要因素是患者常见的多种合并症导致死于癌症以外的其他原因。
同步、交替或分段放化疗可改善局部区域控制。很少有研究显示生存率提高。在临床试验之外的日常实践中采用这种方法之前，需要进行验证性研究。有或没有化疗的加速超分割可能进一步提高控制率。复发性肿瘤同步化疗再程放疗的完全缓解率超过40%。
