Conley B, Jacobs M, Suntharalingam M, Zacharski D, Ord R A, Gray W, Aisner J
Department of Medicine, University of Maryland School of Medicine, USA.
Semin Oncol. 1997 Feb;24(1 Suppl 2):S2-78-S2-80.
Combined chemoradiotherapy is superior to radiotherapy alone for stage III and IV squamous cell carcinoma of the head and neck, and concurrent use of both offers the advantage of synergistic interactions. Our prior trial demonstrated the ease and convenience of administering carboplatin during radiotherapy. Since paclitaxel (Taxol; Bristol-Myers Squibb Company, Princeton, NJ) has activity in squamous cell carcinoma of the head and neck and can act synergistically with both radiotherapy and platinum drugs, we initially added paclitaxel at 45 mg/m2/wk to carboplatin given at 100 mg/m2 during radiotherapy given at conventional fractions. The initial dose of paclitaxel was subsequently reduced to 40 mg/m2/wk. Thirteen of 18 patients entered so far have sufficient follow-up data; 12 are assessable for toxicity and 11 are assessable for response. One died early of progressive disease, two achieved a complete response, six achieved a partial response, and two had stable disease. Toxicities have so far been manageable for the 76 weekly doses administered. Chemotherapy dose reduction was needed in 10 patients. For the planned 100 doses of chemotherapy, 53 (53%) were administered as planned, 23 (23%) were reduced, and 24 (24%) were withheld due to neutropenia or mucositis. There were no toxic deaths, and no patient stopped therapy for toxicity. Paclitaxel/carboplatin can be administered during radiotherapy for squamous cell carcinoma of the head and neck with acceptable toxicities, and further accrual is needed to evaluate the effect of this combination.
对于Ⅲ期和Ⅳ期头颈部鳞状细胞癌，放化疗联合治疗优于单纯放疗，同时使用两者具有协同相互作用的优势。我们之前的试验证明了在放疗期间给予卡铂的简便性。由于紫杉醇（泰素；百时美施贵宝公司，新泽西州普林斯顿）对头颈部鳞状细胞癌有活性，并且可以与放疗和铂类药物协同作用，我们最初在常规分割放疗期间，将紫杉醇以45mg/m²/周的剂量添加到100mg/m²的卡铂中。随后紫杉醇的初始剂量降至40mg/m²/周。到目前为止入组的18例患者中有13例有足够的随访数据；12例可评估毒性，11例可评估反应。1例因疾病进展早期死亡，2例完全缓解，6例部分缓解，2例病情稳定。对于已给药的76次周剂量，毒性目前可控。10例患者需要减少化疗剂量。对于计划的100次化疗剂量，53次（53%）按计划给药，23次（23%）减少剂量，24次（24%）因中性粒细胞减少或粘膜炎而未给药。没有毒性死亡病例，也没有患者因毒性而停止治疗。紫杉醇/卡铂可在头颈部鳞状细胞癌放疗期间给药，毒性可接受，需要进一步积累病例以评估这种联合治疗的效果。
