Allal A S, Bieri S, Miralbell R, Dulguerov P, Bardina A, Lehmann W, Kurtz J M
Division of Radiation Oncology, University Hospital, Geneva, Switzerland.
Ann Oncol. 1997 Jul;8(7):681-4. doi: 10.1023/a:1008260720076.
Alteration of radiation therapy (RT) fractionation and the combination of chemotherapy (CT) with RT represent two predominant fields of current research in the treatment of head and neck carcinomas. To assess the potential integration of these two fields, a retrospective comparison of toxicity and treatment outcome was carried out in stage III-IV patients treated with a concomitant boost RT schedule with or without CT.
Fifty-two patients were treated by RT alone and 35 by RT and CT. In the RT group, there were significantly fewer T3-4 tumors (56% vs. 88%, P = 0.002) and higher proportion of planned neck dissections (35% vs. 14%, P = 0.047). The planned total dose was 69.9 Gy delivered over 5.5 weeks. In 10 cases CT was given before RT and in 25 concomitantly with RT, either alone or with neoadjuvant and/ or adjuvant CT. All patients but two had cisplatin-based (CDDP, 100 mg/m2) CT, associated in 28 patients with 5-fluorouracil (5-FU, 1000 mg/m2/24 h x 5). The median follow-up for the surviving patients was 21 and 31 months for the RT and RT-CT groups respectively.
Grade 3-4 acute toxicity (RTOG) was observed in 73% and 36% of patients, and grade 3 dysphagia in 31% and 57% (P = 0.02) respectively in the RT and RT-CT groups. The rates of grade 3-4 late complications were similar in the two groups (5% vs. 12%). At three years, actuarial loco-regional control (LRC) was 57% and 66% (P = 0.66) and overall survival was 56% and 47% (P = 0.99) in the RT and RT-CT groups respectively.
While acute toxicity was higher compared with RT alone, this accelerated RT schedule was feasible in association with 5-FU/CDDP, even administered concomitantly. Despite the significant proportion of more advanced disease in the RT-CT group, LRC was similar to that obtained by RT alone. Combinations of concomitant boost RT and chemotherapy merit further investigation in prospective trials.
放射治疗（RT）分割方式的改变以及化疗（CT）与RT联合应用是目前头颈部癌治疗研究的两个主要领域。为评估这两个领域潜在的整合效果，对接受或未接受CT的同期增量RT方案治疗的III-IV期患者的毒性和治疗结果进行了回顾性比较。
52例患者仅接受RT治疗，35例患者接受RT和CT联合治疗。RT组中，T3-4期肿瘤明显较少（56%对88%，P = 0.002），计划行颈部清扫术的比例较高（35%对14%，P = 0.047）。计划总剂量为69.9 Gy，分5.5周给予。10例患者在RT前接受CT治疗，25例患者在RT期间同时接受CT治疗，单独或联合新辅助和/或辅助CT治疗。除2例患者外，所有患者均接受以顺铂（CDDP，100 mg/m2）为基础的CT治疗，28例患者联合5-氟尿嘧啶（5-FU，1000 mg/m2/24 h×5）。RT组和RT-CT组存活患者的中位随访时间分别为21个月和31个月。
RT组和RT-CT组分别有73%和36%的患者出现3-4级急性毒性反应（RTOG），3级吞咽困难的发生率分别为31%和57%（P = 0.02）。两组3-4级晚期并发症的发生率相似（5%对12%）。三年时，RT组和RT-CT组的精算局部区域控制率（LRC）分别为57%和66%（P = 0.66），总生存率分别为56%和47%（P = 0.99）。
虽然与单纯RT相比急性毒性更高，但这种加速RT方案与5-FU/CDDP联合应用是可行的，甚至可以同时给药。尽管RT-CT组中更晚期疾病的比例较高，但LRC与单纯RT相似。同期增量RT与化疗的联合应用值得在前瞻性试验中进一步研究。
