Organ preservation for advanced resectable cancer of the base of tongue and hypopharynx: A Southwest Oncology Group trial
Organ preservation for advanced resectable cancer of the base of tongue and hypopharynx: A Southwest Oncology Group trial
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DOI：
10.1200/jco.2005.04.017
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发表时间：
2005-01-01
影响因子：
45.3
通讯作者：
Schuller, DE
中科院分区：
文献类型：
--
作者：
Urba, SG;Moon, J;Schuller, DE
目的：西南肿瘤研究小组设计了一项针对舌底或下咽癌患者的II期试验，以评估在诱导化疗和放化疗后反应者在原发部位的完全组织学反应率。次要终点是器官保存率和保留手术的需要。患者与方法入选59例符合条件的患者；舌底癌37例，下咽癌22例。42%的人患有III期疾病，58%的人患有IV期疾病。诱导化疗为顺铂100 mg/m(2) +氟尿嘧啶1000 mg/m(2)/d 2个周期，持续5天。原发部位反应大于50%的患者接受72Gy放疗和100mg /m(2)顺铂治疗，疗程为3个周期。原发治疗效果不佳的患者应立即进行补救性手术。结果45例（76%）患者在诱导化疗后的初始反应大于50%；43人接受了最终的放化疗。32例患者（54%）在原发部位获得组织学完全缓解，另外9例患者有完全临床缓解，但未进行活检。75%的患者不需要在原发肿瘤部位进行手术。3年总生存率为64%。器官保存的3年无进展生存率为52%。结论该方案对舌底或下咽癌患者进行诱导化疗后再进行明确放化疗，器官保存率高，且不影响患者的生存。
Purpose The Southwest Oncology Group designed a phase II trial for patients with base of tongue or hypopharyngeal cancer to evaluate the complete histologic response rate at the primary site after induction chemotherapy followed by chemoradiotherapy for responders. Secondary end points were the rate of organ preservation and the need for salvage surgery.Patients and Methods Fifty-nine eligible patients were enrolled; 37 had base of tongue cancer, and 22 had hypopharynx cancer. Forty-two percent had stage III disease, and 58% had stage IV disease. Induction chemotherapy was two cycles of cisplatin 100 mg/m(2) and fluorouracil 1,000 mg/m(2)/d for 5 days. Patients who had a greater than 50% response at the primary site were treated with radiation 72Gy and concurrent cisplatin 100 mg/m(2) for three cycles. Patients with less than partial response at the primary had immediate salvage surgery.Results Forty-five patients (76%) had a greater than 50% response at the primary after induction chemotherapy; 43 went on to receive definitive chemoradiotherapy. Thirty-two patients (54%) achieved a histologic complete response at the primary site, and an additional nine patients had a complete clinical response, but biopsy was not done. Seventy-five percent of patients did not require surgery at the primary tumor site. The 3-year overall survival was 64%. The 3-year progression-free survival with organ preservation was 52%.Conclusion Patients with base of tongue or hypopharyngeal cancer treated with this regimen of induction chemotherapy followed by definitive chemoradiotherapy have a good rate of organ preservation without compromise of survival.