Induction chemotherapy in nonlaryngeal human papilloma virus-negative high-risk head and neck cancer: a real-world experience
Induction chemotherapy in nonlaryngeal human papilloma virus-negative high-risk head and neck cancer: a real-world experience
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DOI：
10.1097/cad.0000000000000977
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发表时间：
2020-11-01
影响因子：
2.3
通讯作者：
Marchetti, Paolo
中科院分区：
文献类型：
--
作者：
Mezi, Silvia;Pomati, Giulia;Marchetti, Paolo
诱导化疗在局部晚期、非喉高危型人乳头瘤病毒（HPV）阴性头颈部鳞状细胞癌（HNSCC）多学科治疗中的作用在总生存期（OS）方面尚不确定。本研究的主要目的是确定接受诱导化疗的HNSCC患者生存和结局的可能预测因素。回顾了在Policlinico Umberto I接受诱导化疗的59例IVa/B期HPV阴性非喉HNSCC（主要来源于口腔）患者。根据客观缓解率（ORR）、无进展生存期（PFS）、OS和毒性分析治疗结局。证实了淋巴结状态、ORR、持续吸烟、毒性和OS之间的显著相关性。ORR（在61%的患者中获得）与死亡率降低80%相关（P< 0.0001）。诱导化疗一个周期后早期停药与OS显著缩短相关。16例患者中有15例接受了口腔根治性手术，切缘阴性。42%的患者发生G3-G4毒性。口咽癌和口腔癌患者中分别有42%和21%发生了需要住院治疗的毒性反应。5例患者死于治疗相关原因。口腔患者中未发生治疗相关死亡。G5毒副反应在不同疾病部位有差异（P= 0.05）。诱导化疗在非喉高危HNSCC中是一种积极的策略，最重要的是在口腔癌中，即使具有高毒性（G >= 3）和早期停药率。然而，这些数据需要在进一步和更大规模的研究中得到证实。
The role of induction chemotherapy in the multidisciplinary treatment of locally advanced, nonlaryngeal high-risk human papilloma virus (HPV)-negative head and neck squamous cells carcinoma (HNSCC) is uncertain in terms of overall survival (OS). The primary objective of this study was to identify possible predictive factors of survival and outcome in patients with HNSCC who were treated with induction chemotherapy. Fifty-nine patients with stage IVa/b HPV-negative non-laryngeal HNSCC (mostly originating from the oral cavity) who underwent induction chemotherapy at Policlinico Umberto I were reviewed. Treatment outcomes in term of objective response rate (ORR), progression-free survival (PFS), OS and toxicities were analyzed. A significant association between nodal status, ORR, ongoing smoking use, toxicities and OS was demonstrated. ORR (obtained in 61% of patients) was associated with a reduction in mortality of 80% (P< 0.0001). Early discontinuation after just one cycle of induction chemotherapy was associated to a significantly shorter OS. In oral cavity radical surgery with negative margins was obtained in 15/16 patients. In 42% of patients G3-G4 toxicity occurred. Toxicity requiring hospitalization occurred in 42% and 21% of patients with oropharyngeal and oral cavity carcinoma, respectively. Five patients died of treatment-related causes. No treatment-related mortality occurred in oral cavity patients. G5 toxicities were different according to the sub-sites of disease (P= 0.05). Induction chemotherapy in non-laryngeal high-risk HNSCC is an active strategy, most importantly in oral cavity cancer, even though burdened with a high (G >= 3) toxicity and early discontinuation rate. These data will however need to be confirmed in further and larger studies.