Constenla D O, Hill M E, A'Hern R P, Henk J M, Rhys-Evans P, Breach N, Archer D, Gore M E
Head and Neck Unit, Royal Marsden NHS Trust, London, UK.
Ann Oncol. 1997 May;8(5):445-9. doi: 10.1023/a:1008203613364.
The role of chemotherapy in patients with recurrent squamous cell carcinomas of the head and neck (SCCHN) is unclear. The aim of this study was to assess the ability of combination chemotherapy to control symptoms in this setting.
Using a prospectively accrued database all patients referred for chemotherapy with symptomatic relapse following surgery were identified. Objective response was recorded using standard criteria and maximum symptom response was assessed retrospectively from case notes using a published scoring scale.
A total of 57 (median age 56, range 37-85) patients were studied who had received mainly cisplatin/5-fluorouracil combinations. Thirty-seven had previously received radiotherapy. Fifty-two patients had evaluable disease; 18 (35%) had objective responses (14 PRs and 4 CRs). There were a total of 103 symptoms recorded with eight different individual symptoms. Forty-four (43%) symptoms improved on treatment, 52 (50%) were unchanged and 7 (7%) worsened. The number of patients with improvement in the most frequently recorded symptoms were as follows: pain 11/28 (39%), swelling 12/23 (52%) and dysphagia 6/18 (33%). Sixty-seven percent of patients with objective response also had an improvement in their symptoms but a significant proportion (33%) of non-responders had a symptomatic response. Lack of objective response was not correlated with worsening symptoms. Grade 3/4 toxicity was uncommon (6%-17%) and there were no toxic deaths. A majority of patients (82%) experienced either no change or an improvement in performance status.
These results demonstrate that chemotherapy improves many of the symptoms associated with recurrent SCCHN, without deterioration in performance status. Symptomatic improvement is more likely if there is evidence of significant tumour shrinkage, but even non-responding patients can benefit.
化疗在复发性头颈部鳞状细胞癌（SCCHN）患者中的作用尚不清楚。本研究的目的是评估联合化疗在此情况下控制症状的能力。
利用前瞻性积累的数据库，确定所有因术后症状复发而接受化疗的患者。采用标准标准记录客观缓解情况，并使用已发表的评分量表从病例记录中回顾性评估最大症状缓解情况。
共研究了57例（中位年龄56岁，范围37 - 85岁）主要接受顺铂/5 - 氟尿嘧啶联合化疗的患者。37例患者先前接受过放疗。52例患者疾病可评估；18例（35%）有客观缓解（14例部分缓解和4例完全缓解）。共记录到8种不同的个体症状，总计103个症状。44个（43%）症状在治疗后改善，52个（50%）无变化，7个（7%）恶化。最常记录症状改善的患者数量如下：疼痛11/28（39%）、肿胀12/23（52%）和吞咽困难6/18（33%）。67%有客观缓解的患者症状也有改善，但相当比例（33%）的无反应者有症状缓解。缺乏客观缓解与症状恶化无关。3/4级毒性不常见（6% - 17%），且无因毒性死亡。大多数患者（82%）体能状态无变化或有所改善。
这些结果表明，化疗可改善与复发性SCCHN相关的许多症状，且不导致体能状态恶化。如果有肿瘤明显缩小的证据，症状改善的可能性更大，但即使无反应的患者也能获益。
