Fu K K
Department of Radiation Oncology, University of California, San Francisco, CA 94143-0226, USA.
Semin Radiat Oncol. 1998 Oct;8(4):247-53. doi: 10.1016/s1053-4296(98)80022-2.
Among squamous cell carcinomas of the head and neck, nasopharyngeal carcinoma is probably the most radiosensitive and chemosensitive. It also has the highest incidence of distant metastasis. This article reviews the results of randomized trials of combined chemotherapy and radiotherapy for nasopharyngeal carcinoma to date. Induction chemotherapy with bleomycin, epirubicin, and cisplatin was shown to increase disease-free survival but not overall survival in a trial by the International Nasopharyngeal Cancer Study Group. Concurrent radiotherapy and cisplatin followed by adjuvant cisplatin and 5-fluorouracil infusion significantly decreased local, nodal, and distant failures and increased progression-free and overall survival in the Head and Neck Intergroup Trial. The toxicity of combined chemotherapy and radiotherapy, however, primarily acute toxicity, was significantly greater than that of radiotherapy alone. Further clinical trials using novel drugs, altered fractionation radiotherapy and chemotherapy dose schedules, new radiotherapy techniques, and other treatment modifiers are needed to further improve the therapeutic ratio.
在头颈部鳞状细胞癌中，鼻咽癌可能是对放疗和化疗最敏感的。它也是远处转移发生率最高的。本文综述了迄今为止鼻咽癌放化疗联合随机试验的结果。国际鼻咽癌研究组的一项试验表明，使用博来霉素、表柔比星和顺铂进行诱导化疗可提高无病生存率，但不能提高总生存率。在头颈部肿瘤协作组试验中，同步放疗和顺铂，随后辅助使用顺铂和5-氟尿嘧啶输注，显著降低了局部、区域和远处复发率，并提高了无进展生存率和总生存率。然而，放化疗联合的毒性，主要是急性毒性，明显大于单纯放疗。需要进一步开展临床试验，使用新型药物、改变分割放疗和化疗剂量方案、新的放疗技术以及其他治疗调整措施，以进一步提高治疗增益比。
