Brizel D M
Department of Radiation Oncology, Duke University Medical Center, Durham, NC 27710, USA.
Semin Radiat Oncol. 1998 Oct;8(4):237-46. doi: 10.1016/s1053-4296(98)80021-0.
Cure of locally advanced squamous cell carcinoma of the head and neck (SCCHN) is uncommon with radiotherapy alone. The desire for organ preservation in advanced resectable SCCHN and the need for better local therapy for unresectable disease have led to the development of treatment using radiotherapy and concurrent chemotherapy (RT/CCT). RT/CCT is an attractive strategy because the appropriate drug(s) may enhance radiation effects and independently contribute to local cytotoxicity. Concurrent treatment may combat tumor repopulation and provide the earliest possible treatment of distant micrometastases. RT/CCT may be integrated in synchronous or alternating schemes. Most randomized trials of RT/CCT versus radiation alone show superior local control, disease-free survival, and survival with combined modality treatment. Improved efficacy with RT/CCT is accompanied by increased acute toxicity, which necessitates compromises in the treatment design of most programs. Consequently the most effective RT/CCT regimen has not been defined. Chemical modifiers of toxicity are now under investigation in clinical trials and may allow for improved integration of RT/CCT.
仅采用放疗治愈局部晚期头颈部鳞状细胞癌（SCCHN）的情况并不常见。对于可切除的晚期SCCHN患者，人们希望保留器官，而对于不可切除的疾病则需要更好的局部治疗方法，这促使了放疗联合同期化疗（RT/CCT）治疗方法的发展。RT/CCT是一种有吸引力的策略，因为合适的药物可能会增强放疗效果，并独立发挥局部细胞毒性作用。同期治疗可以对抗肿瘤再增殖，并尽早治疗远处微转移灶。RT/CCT可以采用同步或交替方案。大多数关于RT/CCT与单纯放疗对比的随机试验表明，联合治疗在局部控制、无病生存率和总生存率方面更具优势。RT/CCT疗效的提高伴随着急性毒性的增加，这使得大多数治疗方案在设计上需要做出妥协。因此，最有效的RT/CCT方案尚未确定。目前正在临床试验中研究毒性的化学修饰剂，这可能会改善RT/CCT的联合应用。
