Epstein A H, Lebovics R S, Van Waes C, Smith J, Okunieff P, Cook J A
Department of Radiology and Nuclear Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.
Laryngoscope. 1998 Jul;108(7):1090-4. doi: 10.1097/00005537-199807000-00025.
Locally advanced cancers of the head and neck require aggressive treatment, often with limited effectiveness and significant toxicity and morbidity. This pilot study was designed to assess tolerance using combined hyperfractionated radiotherapy and the halogenated pyrimidine radiosensitizer 5'-iododeoxyuridine (IdUrd).
This was a prospective single-arm study open to patients with advanced head and neck cancers that had a poor chance of control with conventional radiation therapy. Patients were treated with hyperfractionated radiation therapy at standard doses in combination with an IdUrd infusion and observed for tumor response and normal tissue tolerances.
Radiation therapy was delivered in fractions of 1.2 Gy or 1.5 Gy twice daily to a total dose in the range of 70 to 76 Gy. IdUrd was delivered as an intravenous infusion (1000 mg/m2 per day) for a maximum of 14 days at the beginning and then again during the middle of the radiotherapy.
Twelve patients with advanced squamous cell lesions were enrolled and 11 were observed to have complete clinical remissions. Seven patients remained clinically free of local disease at the time of death or most recent follow-up. Acute toxicities, usually hematologic or mucosal, were severe and all patients required treatment modifications and considerable supportive care.
Although a high rate of response was achieved using this regimen, the toxicities are prohibitive. The kinetic profile of IdUrd incorporation suggests the need for future studies using repetitive short courses of IdUrd.
局部晚期头颈部癌症需要积极治疗，但其效果往往有限，且毒性和发病率较高。本试点研究旨在评估联合超分割放疗与卤代嘧啶放射增敏剂5'-碘脱氧尿苷（IdUrd）的耐受性。
这是一项前瞻性单臂研究，纳入常规放疗控制机会较小的晚期头颈部癌症患者。患者接受标准剂量的超分割放疗，联合IdUrd输注，并观察肿瘤反应和正常组织耐受性。
放疗采用每次1.2 Gy或1.5 Gy，每天两次，总剂量在70至76 Gy范围内。IdUrd在放疗开始时静脉输注（每天1000 mg/m²），最多14天，然后在放疗中期再次输注。
12例晚期鳞状细胞病变患者入组，11例观察到完全临床缓解。7例患者在死亡或最近一次随访时临床上无局部疾病。急性毒性反应，通常为血液学或黏膜毒性，较为严重，所有患者均需要调整治疗方案并给予大量支持治疗。
尽管该方案取得了较高的缓解率，但毒性令人难以接受。IdUrd掺入的动力学特征表明，未来需要使用重复短疗程的IdUrd进行研究。
