Benasso M, Corvò R, Numico G, Cavallari M, Blengio F, Sanguineti G, Rosso M, Merlano M
Department of Medical Oncology I, Istituto Nazionale per la Ricerca sul Cancro, Genova, Italy.
Anticancer Res. 1995 Nov-Dec;15(6B):2651-4.
In advanced squamous cell carcinoma of the head and neck, the superiority of a chemo-radiotherapy combination over radiotherapy alone has been strongly suggested. However, the best modality to combine the two treatments has still to be determinated. A pilot study was designed, testing a combination of two standard chemo- and radiotherapy regimens concomitantly administered.
26 patients, with unresectable squamous cell carcinoma of the head and neck, were treated with three cycles of chemotherapy (cisplatin 20 mg/m2/day and fluorouracil 200 mg/m2/day as an intravenous bolus, for 5 consecutive days, every 21) simultaneously delivered with radiation (66-70 Gy/33-35 fractions/7 weeks). In order to reduce the mucoseal toxicity. observed in the first 15 patients, 1 week of pause was inserted after the third week of treatment in the subsequent 11 patients.
Grade III-IV mucositis was detected in 40% of patients treated without pause after the third week of treatment and in 9% of those treated with. Complete responses were obtained in 13/26 patients (50%) and partial responses in 8/26 (31%). 1 stable disease, 3 early deaths (1 because of toxicity) and 1 lost before being evaluated were considered as treatment failures (19%).
This concomitant chemo-radiotherapy approach showed a good antitumour activity but mucoseal toxicity is too high if no pause is planned during the treatment.
在晚期头颈部鳞状细胞癌中，强烈提示化疗与放疗联合应用优于单纯放疗。然而，两种治疗联合的最佳方式仍有待确定。设计了一项初步研究，测试两种标准化疗和放疗方案同时给药的联合方式。
26例不可切除的头颈部鳞状细胞癌患者接受三个周期的化疗（顺铂20mg/m²/天和氟尿嘧啶200mg/m²/天静脉推注，连续5天，每21天重复），同时进行放疗（66 - 70Gy/33 - 35次分割/7周）。为了降低在前15例患者中观察到的黏膜毒性，在随后的11例患者治疗的第三周后插入1周的休息期。
在治疗第三周后未休息的患者中，40%检测到III - IV级黏膜炎，而休息的患者中为9%。26例患者中有13例（50%）获得完全缓解，8例（31%）获得部分缓解。1例病情稳定，3例早期死亡（1例因毒性），1例在评估前失访，这些被视为治疗失败（19%）。
这种同步放化疗方法显示出良好的抗肿瘤活性，但如果在治疗期间不安排休息，黏膜毒性过高。
