Pirtoli L, Bellezza A, Tucci E, Pepi F, Crastolla A M, Farzad M, Bindi M, Sebaste L
Unità Operativa di Radioterapia, Università di Siena.
Radiol Med. 1995 Jul-Aug;90(1-2):94-101.
The management of advanced inoperable head and neck cancer is often based on a combined chemo-radiotherapy approach. No definitive conclusions on the effectiveness of this combination can be drawn from clinical trials because these neoplasms are heterogeneous and treatment schedules vary. Many scientific trials test highly toxic combinations, whereas not only good results but also low toxicity are mandatory in the current practice. We report the results obtained in 90 consecutive patients affected with inoperable head and neck cancers in stages III-IV, or relapsed after surgery. Chemotherapy consisted of a cis-platinum/bleomycin induction phase, followed by weekly administrations of cis-platinum simultaneous with conventional irradiation. The objective remission rates, achieved at the end of the induction chemotherapy and the simultaneous chemo-radiotherapy phases, were respectively 55.5% and 84.5%. The tumor disappeared in 39% of cases, by the end of the whole treatment. With the Kaplan-Meier method, 3-year overall, progression-free and relapse-free survival rates were 21.20%, 22.25% and 38.75%, respectively. The overall survival rate, calculated with the "log-rank" test according to the stage and the site of the primary tumor, exhibited no significant differences. In contrast, significant differences (p < 0.05) were demonstrated, according to treatment intent (curative radical: 26%, vs palliative: 0%) and to the achievement of an objective response at the end of induction chemotherapy--i.e., 48% 3-year survival rate, vs 7% in chemotherapy resistant cancer patients. When limiting the analysis to 72 radically irradiated patients, however, the achievement of CR after induction chemotherapy lost its prognostic value. Toxicity was not substantially higher than with conventional irradiation. Our results are in agreement with literature data on this subject which, regarding survival, fail to prove such integrated treatments as ours better than irradiation alone. In contrast, the preliminary combination of chemotherapy and irradiation is clearly better for the patients waiting to receive radiation therapy, because tumor volume and related symptoms markedly decrease after induction chemotherapy. Currently the best survival rates (about 50% at 3 years) with chemo-radiotherapy are obtained, in this kind of cancer, by combining cis-platinum and continuous-infusion 5-fluorouracil, simultaneous with irradiation. However, frequent and severe toxicity is reported. Should such a modality be adopted in the current practice, patients should be selected according to their medical conditions.
晚期不可切除的头颈癌的治疗通常基于放化疗联合的方法。由于这些肿瘤具有异质性且治疗方案各不相同，因此无法从临床试验中得出关于这种联合治疗有效性的明确结论。许多科学试验测试的是高毒性的联合方案，而在当前的临床实践中，不仅要有好的治疗效果，低毒性也是必不可少的。我们报告了90例连续的III - IV期不可切除的头颈癌患者或术后复发患者的治疗结果。化疗包括顺铂/博来霉素诱导期，随后每周给予顺铂并同时进行常规放疗。诱导化疗结束时和同步放化疗阶段结束时的客观缓解率分别为55.5%和84.5%。在整个治疗结束时，39%的病例肿瘤消失。采用Kaplan - Meier方法，3年总生存率、无进展生存率和无复发生存率分别为21.20%、22.25%和38.75%。根据原发肿瘤的分期和部位，用“对数秩”检验计算的总生存率无显著差异。相比之下，根据治疗目的（根治性：26%，姑息性：0%）以及诱导化疗结束时是否达到客观缓解，即达到客观缓解的患者3年生存率为48%，化疗耐药的癌症患者为7%，差异有统计学意义（p < 0.05）。然而，当将分析局限于72例接受根治性放疗的患者时，诱导化疗后达到完全缓解失去了其预后价值。毒性并不比传统放疗高很多。我们的结果与该主题的文献数据一致，关于生存率，未能证明我们这种综合治疗比单纯放疗更好。相比之下，化疗和放疗的初步联合对等待接受放疗的患者明显更好，因为诱导化疗后肿瘤体积和相关症状明显减轻。目前，在这种癌症中，通过顺铂和持续静脉输注5 - 氟尿嘧啶联合放疗可获得最佳的化疗放疗生存率（3年约50%）。然而，有报道称其毒性频繁且严重。在当前的临床实践中若采用这种治疗方式，应根据患者的病情进行选择。
