Jereczek-Fossa B, De Braud F, Gasparetto M, De Pas T, Tradati N, Leonardi M C, Marsiglia H R, Orecchia R
Department of Oncology and Radiotherapy, Medical University of Gdansk, Poland.
Strahlenther Onkol. 1998 Sep;174(9):457-61. doi: 10.1007/BF03038623.
To evaluate the feasibility of induction chemotherapy followed by concomitant chemotherapy and hyperfractionated irradiation in locally advanced, inoperable head and neck cancer.
A pilot study was undertaken comprising 3 cycles of cisplatinum (100 mg/m2, day 1) and 5-fluorouracil (1000 mg/m2 in continuous intravenous infusion over the first 120 h) followed by bifractionated radiotherapy applied to tumor/involved lymph nodes up to the dose of 74.4 Gy given in 2 fractions of 1.2 Gy daily for 5 days a week combined with concomitant weekly cisplatinum infusion (50 mg/m2).
Six patients were enrolled in the study. All of them completed the protocol therapy. Severe mucositis and myelotoxicity were the most common acute side effects observed in all and in 5 of the patients, respectively. Acute toxicity required interruption of concomitant chemotherapy in 5 cases and in 2 interruption of radiotherapy was necessary. Opioid analgesic parenteral therapy was administered in 4 patients. Three of them had to be hospitalized. One patient experienced cerebral stroke 1 day after the completion of therapy and died 7 days later. Due to high acute toxicity, patient accrual was terminated after 6 patients. At the mean follow-up of 17 months, 4 patients are alive, 3 of them are free of disease and in 1 local progression has been diagnosed.
High acute toxicity of induction cisplatinum and 5-fluorouracil followed by concomitant cisplatinum and hyperfractionated irradiation calls for less toxic treatment schedules in locally advanced inoperable head and neck cancer.
评估诱导化疗后序贯同步化疗及超分割放疗用于局部晚期、不可切除的头颈癌的可行性。
开展一项前瞻性研究，包括3个周期的顺铂（100mg/m²，第1天）和5-氟尿嘧啶（1000mg/m²，在最初120小时持续静脉输注），随后对肿瘤/受累淋巴结进行双分割放疗，剂量达74.4Gy，每天分2次，每次1.2Gy，每周5天，同时每周静脉输注顺铂（50mg/m²）。
6例患者入组本研究。所有患者均完成了方案治疗。严重黏膜炎和骨髓毒性分别是所有患者及5例患者中最常见的急性不良反应。急性毒性导致5例患者同步化疗中断，2例患者放疗中断。4例患者接受了阿片类镇痛药物的肠外治疗。其中3例患者需住院治疗。1例患者在治疗结束后1天发生脑卒中，7天后死亡。由于急性毒性高，在6例患者入组后终止了患者招募。平均随访17个月时，4例患者存活，其中3例无疾病，1例被诊断为局部进展。
诱导性顺铂和5-氟尿嘧啶联合同步顺铂及超分割放疗的急性毒性高，提示对于局部晚期不可切除的头颈癌需要采用毒性更低的治疗方案。
