Dragovic J, Doyle T J, Tilchen E J, Nichols R D, Benninger M S, Carlson E R, Boyd S B, Jacobsen G R
Department of Radiation Oncology, Henry Ford Hospital, Detroit, MI 48202, USA.
Cancer. 1995 Nov 1;76(9):1655-61. doi: 10.1002/1097-0142(19951101)76:9<1655::aid-cncr2820760923>3.0.co;2-q.
Stage IV inoperable head and neck cancer has a 2-year mortality rate of greater than 70% when treated with conventional radiotherapy. A Phase II study was undertaken to evaluate the effects of concomitant chemotherapy and accelerated, interrupted, twice-a-day radiotherapy on tumor response, locoregional control, survival, and morbidity.
Thirty-four patients with Stage IV inoperable squamous cell carcinoma of the head and neck and a minimum follow-up of 36 months were evaluated. Concomitant chemoradiotherapy was administered during weeks 1, 3, and 5 (with planned breaks during weeks 2 and 4), consisting of cisplatin 60 mg/m2 on day 1, continuous 5-day infusion of 5-fluorouracil, 750 mg/m2 per day, and radiotherapy, 2 Gy twice a day, more than 6 hours apart, followed by 3 days of radiation therapy alone (final "boost") in week 6, for a total dose of 70 Gy and treatment duration of 5 1/2 weeks (38 days).
Twenty-seven patients achieved a clinical complete response (82%). Actuarial locoregional control at 3 years was 73% and the actuarial 3-year survival probability, including all deaths, was 38%. All locoregional recurrences were manifested within 12 months. Of the 20 deaths, 12 were tumor related (locoregional and/or metastatic), 3 were treatment related, and 5 were due to other causes. Acute toxicity consisted of grade 3 mucositis and dysphagia and grade 2-3 leukopenia, not requiring treatment interruption or cessation.
Concomitant accelerated radiation therapy and chemotherapy is a feasible treatment approach in this prognostically poor patient population, yielding dramatic tumor responses and impressive locoregional control at the cost of somewhat increased acute toxicity. Although serious late complications have not been observed, caution should be exercised in view of the relatively short follow up.
采用传统放疗治疗时，IV期不可手术切除的头颈癌2年死亡率超过70%。开展了一项II期研究，以评估同步化疗和加速、间断、每日两次放疗对肿瘤反应、局部区域控制、生存率和发病率的影响。
对34例IV期不可手术切除的头颈部鳞状细胞癌患者进行评估，最短随访36个月。在第1、3和5周进行同步放化疗（第2和4周计划休息），包括第1天给予顺铂60mg/m²，5-氟尿嘧啶每日750mg/m²连续5天静脉输注，以及每日两次放疗，每次2Gy，间隔超过6小时，随后在第6周单独进行3天放疗（最终“强化”），总剂量70Gy，治疗持续时间5.5周（38天）。
27例患者达到临床完全缓解（82%）。3年精算局部区域控制率为73%，包括所有死亡情况的3年精算生存概率为38%。所有局部区域复发均在12个月内出现。20例死亡患者中，12例与肿瘤相关（局部区域和/或转移），3例与治疗相关，5例因其他原因死亡。急性毒性包括3级黏膜炎和吞咽困难以及2 - 3级白细胞减少，无需中断或停止治疗。
同步加速放疗和化疗对于这类预后较差的患者群体是一种可行的治疗方法，可产生显著的肿瘤反应和令人印象深刻的局部区域控制，但代价是急性毒性略有增加。尽管尚未观察到严重的晚期并发症，但鉴于随访时间相对较短，仍应谨慎。
