Re-irradiation with concomitant chemotherapy of unresectable recurrent head and neck cancer: A potentially curable disease
Re-irradiation with concomitant chemotherapy of unresectable recurrent head and neck cancer: A potentially curable disease
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DOI：
10.1093/oxfordjournals.annonc.a010793
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发表时间：
1996-11-01
影响因子：
50.5
通讯作者：
Vokes, EE
中科院分区：
文献类型：
--
作者：
Haraf, DJ;Weichselbaum, RR;Vokes, EE
目的：本研究的目的是回顾先前接受过放射治疗的局部或区域复发或持续性头颈癌患者认为无法切除治愈的联合放化疗的结果。方法和材料：我们确定了45例在1986年至1993年间接受治疗的不可切除的局部或区域复发性疾病患者，他们在芝加哥大学接受了四项伴随放化疗I/II期研究中的一项。所有患者均接受羟基脲（HU）， 5-氟尿嘧啶（5-FU）和伴随放射治疗，每隔一周（FHX）。在三项研究中，顺铂被添加到FHX中。结果：在一个疾病几乎普遍致命的患者队列中，5年的总生存率、无进展生存率和局部/区域控制率分别为14.6%、13.5%和20%。5例（11%）患者出现致命的治疗相关并发症。其中两个并发症与放射治疗有关。逐步Cox回归分析显示，剂量和方案与生存、无进展生存和局部/区域控制显著相关。与辐射剂量直接相关，与初始FHX剂量递增研究呈负相关。接受58 Gy以上治疗的患者2年生存率为35%，而接受58 Gy以下治疗的患者2年生存率为8%。结论：我们的研究结果表明，如果使用杀瘤剂量，复发性头颈癌的积极再照射合并化疗可以治愈一些毒性可接受的患者。这些结果与历史上单独的化疗系列形成对比，后者导致有限的短期缓解，几乎没有治愈的机会。因此，在多中心或合作组随机试验中，应进一步研究再放疗联合化疗作为单独化疗的替代方案。
Purpose: The purpose of this study was to review the outcome following concomitant chemoradiation therapy in previously irradiated patients with locally or regionally recurrent or persistent head and neck cancer considered unresectable for cure.Methods and materials: We identified 45 patients treated between 1986 and 1993 with unresectable locally or regionally recurrent disease who were treated on one of four concomitant chemoradiotherapy phase I/II studies at the University of Chicago. All patients received hydroxyurea (HU), 5-fluorouracil (5-FU) and concomitant radiation therapy on an alternate week schedule (FHX). Cisplatin was added to FHX in three of the studies.Results: The overall survival, progression-free survival, and local/regional control at 5 years was 14.6%, 13.5% and 20%, respectively, in a cohort of patients whose disease is almost universally fatal. Fatal treatment related complications were observed in 5 (11%) of patients. Two of these complications were related to radiation therapy. Stepwise Cox regression analysis revealed that dose and protocol were significantly correlated with survival, progression-free survival and local/regional control. A direct correlation was observed with radiation dose and an inverse correlation was observed with the initial FHX dose escalation study. The 2-year survival was 35% in patients receiving over 58 Gy compared to 8% for those receiving less than 58 Gy.Conclusions: Our results show that aggressive re-irradiation with concomitant chemotherapy of recurrent head and neck cancer results in the cure of some patients with acceptable toxicity if tumoricidal doses are applied. These results are in contrast to historical series of chemotherapy alone which results in limited palliation of brief duration and almost no chance of cure. Thus, re-irradiation with concomitant chemotherapy should be further investigated as an alternative to chemotherapy alone in multi-center or cooperative group randomized trials.