Schnabel T, Zamboglou N, Kolotas C, Hartmann A, Schmitt G
Department of Radiation Oncology, Heinrich Heine University, Düsseldorf, FRG.
Oncology. 1993 Nov;50 Suppl 2:16-22. doi: 10.1159/000227256.
From 1987 to 1991, 100 evaluable patients with advanced head and neck carcinomas (T2-4, N0-3) were treated with radiotherapy and simultaneous carboplatin. Tumors were located in the oral cavity in 33 patients, oropharynx in 8 patients, and hypopharynx in 7 patients. Four patients had a tumor of the epipharynx, 3 of the larynx, and 45 had involvement of two or more compartments. Radiotherapy was performed in a fractionation of 5 x 2 Gy/week up to a dose of 50 Gy. Carboplatin was administered in a dose of 60 or 70 mg/m2 from days 1-5 and 29-33. After a 2-week interval, tumor involution was evaluated and a decision was made on the patients' operability. In cases of inoperability, radiotherapy was continued up to a dose of 70-74 Gy. Thirty patients underwent surgery after 50 Gy. Eight patients showed a histologically complete remission (CR), 7 showed microscopic residual tumor, and 15 showed macroscopic tumor. Seventy patients were treated with radiotherapy and concomitant carboplatin only. Thirty-nine of them achieved a CR and 30 a partial remission (PR). The residual tumor was operable in 8 of the latter patients. Only a minor response was achieved in the remaining patient. At the end of the treatment 77 patients achieved a CR with this combined modality. From 1990 to 1992, 20 patients with locally advanced head and neck carcinomas underwent hyperfractionated accelerated radiotherapy (2 x 1.6 Gy/day, 5 days per week: total dose, 64-67.2 Gy) and simultaneous intravenous carboplatin (60 mg/m2, days 1-5 and 29-33) in a pilot study. Fifteen patients had T4 and 5 had T3 tumors. Six weeks after the end of treatment, 16 patients (80%) had CR, and PR was seen in the other 4 patients (20%). Overall and disease-free survival at 1 year was 82 and 81%, respectively. Although acute side effects were more pronounced compared with conventional irradiation, this treatment regimen is feasible and the initial CR rate of 80% is encouraging. Because of the results achieved with hyperfractionated accelerated radiotherapy, we initiated a multicenter randomized study in November 1991. Patients with advanced head and neck carcinomas are either randomized for conventional radiotherapy with carboplatin or hyerfractionated accelerated irradiation with carboplatin. Results will be forthcoming.
1987年至1991年期间，100例可评估的晚期头颈癌患者（T2 - 4，N0 - 3）接受了放疗及同步卡铂治疗。33例患者肿瘤位于口腔，8例位于口咽，7例位于下咽。4例患者肿瘤位于上咽，3例位于喉，45例患者肿瘤累及两个或更多区域。放疗采用每周5次、每次2 Gy的分割方式，总剂量达50 Gy。卡铂在第1 - 5天和第29 - 33天以60或70 mg/m²的剂量给药。间隔2周后评估肿瘤退缩情况，并决定患者是否可进行手术。对于不可手术的患者，放疗继续至剂量达70 - 74 Gy。30例患者在接受50 Gy放疗后接受了手术。8例患者组织学上达到完全缓解（CR），7例有微小残留肿瘤，15例有肉眼可见肿瘤。70例患者仅接受了放疗及同步卡铂治疗。其中39例达到CR，30例达到部分缓解（PR）。后一组患者中有8例残留肿瘤可手术切除。其余患者仅获得轻微缓解。治疗结束时，77例患者通过这种联合治疗方式达到CR。1990年至1992年期间，20例局部晚期头颈癌患者在一项初步研究中接受了超分割加速放疗（每天2次，每次1.6 Gy，每周5天：总剂量64 - 67.2 Gy）及同步静脉注射卡铂（60 mg/m²，第1 - 5天和第29 - 33天）。15例患者为T4期肿瘤，5例为T3期肿瘤。治疗结束6周后，16例患者（80%）达到CR，另外4例患者（20%）为PR。1年时的总生存率和无病生存率分别为82%和81%。尽管与传统放疗相比急性副作用更明显，但该治疗方案可行，80%的初始CR率令人鼓舞。鉴于超分割加速放疗取得的结果，我们于1991年11月启动了一项多中心随机研究。晚期头颈癌患者被随机分为接受卡铂同步的传统放疗组或卡铂同步的超分割加速放疗组。结果即将公布。
