DeCIDE and PARADIGM: nails in the coffin of induction chemotherapy in head and neck squamous cell carcinoma?
DeCIDE and PARADIGM: nails in the coffin of induction chemotherapy in head and neck squamous cell carcinoma?
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DOI：
10.1007/s12094-012-0970-4
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发表时间：
2013-03-01
影响因子：
3.4
通讯作者：
Roques, T. W.
中科院分区：
文献类型：
--
作者：
Loo, S. W.;Geropantas, K.;Roques, T. W.
诱导化疗于 20 世纪 70 年代首次用于治疗头颈鳞状细胞癌 (SCCHN)。在先前未经治疗的肿瘤中观察到较高的总体缓解率[1]，并且注意到诱导化疗的反应与放疗后良好结果之间的相关性[2]。尽管如此，许多随后的随机研究和荟萃分析未能证明使用诱导化疗与单独局部治疗相比具有显着的生存优势[3]。当分析仅限于使用铂和 5-氟尿嘧啶 (PF) 作为诱导方案的研究时，发现 5 年生存率绝对改善了 5%。然而，同步放化疗（CRT）观察到的更大的生存获益却掩盖了这一点。因此，CRT 被广泛接受为局部晚期 SCCHN 患者非手术治疗的护理标准。近年来，人们对在 SCCHN 中使用诱导化疗重新产生了兴趣。 CRT 提高了局部肿瘤控制和生存率，导致治疗失败模式发生转变，与局部复发相比，远处复发的发生率更高，尤其是在就诊时患有晚期淋巴结疾病的患者中[4]。尽管诱导化疗对局部控制的影响有限，但它在减少远处疾病复发方面比同步化疗更有效[3]。通过在 CRT 中添加多药诱导化疗，采用称为序贯放化疗 (SCRT) 的治疗模式，可以提高患者的生存率
Induction chemotherapy was first used in squamous cell carcinoma of the head and neck (SCCHN) in the 1970s. High overall response rates were observed in previously untreated tumours [1] and a correlation between response to induction chemotherapy and favourable outcome following radiotherapy was noted [2]. Numerous subsequent randomised studies and meta-analyses nonetheless failed to demonstrate a significant survival advantage with the use of induction chemotherapy compared with locoregional treatment alone [3]. A marginally significant 5% absolute improvement in 5 year survival was seen when analysis was restricted to studies using a platin and 5-fluorouracil (PF) as the induction regimen. This was however overshadowed by the larger survival benefit observed with concurrent chemoradiation (CRT). As a result, CRT became widely accepted as the standard of care in the nonsurgical management of patients with locoregionally advanced SCCHN.Recent years have witnessed a renewed interest in the use of induction chemotherapy in SCCHN. Increased locoregional tumour control and survival with CRT have resulted in a shift in the pattern of treatment failure, with a higher incidence of distant relapse compared with locoregional recurrence, especially in patients with advanced nodal disease at presentation [4]. Although induction chemotherapy has a limited impact on locoregional control, it is more effective than concurrent chemotherapy at reducing distant disease relapse [3]. By adding multi-agent induction chemotherapy to CRT, in a treatment paradigm known as sequential chemoradiotherapy (SCRT), survival of patients