del Campo J M, Felip E, Giralt J, Raspall G, Bescos S, Casado S, Maldonado X
Medical Oncology Service, Hospital General Universitari Vall d'Hebron, Barcelona, Spain.
Am J Clin Oncol. 1997 Feb;20(1):97-100. doi: 10.1097/00000421-199702000-00022.
Combined chemoradiotherapy (CT/RT) treatments appear to yield better results for advanced tumours of the head and neck than do conventional therapies. In the present study, CT/RT was used preoperatively in unresectable tumors of the oral cavity and oropharynx. Forty patients were entered prospectively into a phase II study. Treatment consisted of three cycles of chemotherapy with cisplatin and 5-day infusion of fluorouracil (FU), and the addition of simultaneous radiotherapy (30 Gy) from the second to third cycles. Patients with resectable residual disease or complete clinical response underwent surgery. All patients later received a second phase of irradiation (30 Gy) and two cycles of chemotherapy only in responders. During the first phase of treatment, 22 (55%) patients presented mucositis grades III-IV. Mean weight loss was 7%. Twelve patients were admitted for parenteral nutrition. Thirty-six (90%) patients obtained clinical response, which was complete in 15 (37%). Thirty-two of the 40 underwent surgery. The percentage of pathologic complete responses (PCR) was 35% (14 patients). With a median follow-up of 21 months, the median survival of patients was 23 months, and 19 (47%) of them are disease-free. A high PCR rate was attained with this treatment regimen. Toxicity was significant, but tolerable with adequate support measures.
对于晚期头颈肿瘤，放化疗联合治疗似乎比传统疗法效果更好。在本研究中，放化疗联合治疗被用于术前无法切除的口腔和口咽肿瘤。40例患者前瞻性地进入一项II期研究。治疗包括三个周期的顺铂化疗和5天的氟尿嘧啶（FU）输注，并在第二至第三周期同时进行放疗（30 Gy）。有可切除残留病灶或达到完全临床缓解的患者接受手术。所有患者随后均接受第二阶段放疗（30 Gy），仅缓解者接受两个周期化疗。在治疗的第一阶段，22例（55%）患者出现III-IV级黏膜炎。平均体重减轻7%。12例患者接受肠外营养支持。36例（90%）患者获得临床缓解，其中15例（37%）完全缓解。40例患者中有32例接受了手术。病理完全缓解（PCR）率为35%（14例患者）。中位随访21个月，患者的中位生存期为23个月，其中19例（47%）无疾病存活。该治疗方案获得了较高的PCR率。毒性反应显著，但在采取适当支持措施的情况下可耐受。
