Glicksman A S, Slotman G, Doolittle C, Clark J, Koness J, Coachman N, Posner M, DeRosa E, Wanebo H
Department of Radiation Oncology, Roger Williams Medical Center/Brown University, Providence, RI 02908.
Int J Radiat Oncol Biol Phys. 1994 Dec 1;30(5):1043-50. doi: 10.1016/0360-3016(94)90308-5.
This study was undertaken to assess the efficacy of concurrent cis-platinum and radiation in patients with advanced head and neck cancer and to determine if patients responding to the preoperative regimens may be cured without radical surgery.
One hundred and one patients with potentially operable Stage III and IV squamous cell carcinoma of the head and neck received 45 Gy at 1.8 Gy fractions and continuous infusion cis-platinum 20 mg/m2 over 24 h on days 1 through 4 and 22 through 25 of the radiation schedule. Three to 4 weeks later, radical surgery of the primary site and neck dissections for patients presenting with cervical adenopathy was undertaken or if a complete response had been achieved, continued with radiation to 72 Gy with another course of concurrent continuous infusion cis-platinum.
Complete and partial responses were achieved in 92% of the primary sites and 95% of the nodes. Over 80% of the patients were rendered tumor free at surgery after only the initial course of chemotherapy and radiation. There were no grade 3 or 4 toxicities from chemotherapy and radiation. Ninety-five percent of the patients who initiated treatment completed it. With a median follow-up of 41 months for all patients, 49% of the patients have survived disease free up to 9 years, independent of whether or not their primary tumors were resected or were treated definitively by further chemotherapy sensitized radiation. The disease-specific survival is 78% after 3 years with no local failures thereafter.
These findings suggest that continuous infusion cis-platinum administered concurrently with radiotherapy can improve survival in advanced head and neck cancer. Patients responding to the preoperative regimen may be cured without radical surgery, which can be reserved for salvage.
本研究旨在评估顺铂与放疗同步治疗晚期头颈癌患者的疗效，并确定对术前治疗方案有反应的患者是否可不进行根治性手术而治愈。
101例潜在可手术切除的头颈鳞状细胞癌Ⅲ期和Ⅳ期患者，在放疗期间第1至4天和第22至25天接受1.8Gy分次照射，总量45Gy，同时持续静脉输注顺铂20mg/m²，持续24小时。3至4周后，对出现颈部淋巴结病变的患者进行原发部位的根治性手术及颈部淋巴结清扫术；若已达到完全缓解，则继续放疗至72Gy，并再进行一个疗程的顺铂同步持续静脉输注。
原发部位和淋巴结的完全缓解率和部分缓解率分别为92%和95%。仅经过初始化疗和放疗疗程后，超过80%的患者在手术时肿瘤消失。化疗和放疗未出现3级或4级毒性反应。95%开始治疗的患者完成了治疗。所有患者的中位随访时间为41个月，49%的患者无病生存长达9年，无论其原发肿瘤是否切除或是否通过进一步的化疗增敏放疗进行确定性治疗。3年后疾病特异性生存率为78%，此后无局部复发。
这些研究结果表明，顺铂同步放疗可提高晚期头颈癌患者的生存率。对术前治疗方案有反应的患者可不进行根治性手术而治愈，根治性手术可留作挽救性治疗。
