Hyperfractionated irradiation with or without concurrent chemotherapy for locally advanced head and neck cancer
Hyperfractionated irradiation with or without concurrent chemotherapy for locally advanced head and neck cancer
复制标题
DOI：
10.1056/nejm199806183382503
复制
发表时间：
1998-06-18
影响因子：
158.5
通讯作者：
Prosnitz, LR
中科院分区：
文献类型：
--
作者：
Brizel, DM;Albers, ME;Prosnitz, LR
背景放射治疗往往是晚期头颈癌的主要治疗方法，但局部复发率高，生存率低。目的探讨超分割放疗加化疗(联合治疗)是否优于单纯超分割放疗。方法晚期头颈部肿瘤患者单纯采用超分割放疗，每日2次，共125cGy7500cGy.联合治疗组接受125cGy2次/d，7000cGy1次/d，第1周和第6周顺铂12 mg/m2/d和氟尿嘧啶600 mg/m2/d治疗5d。大多数患者在放疗结束后接受两个周期的顺铂和氟尿嘧啶治疗。结果122例患者中，116例进入分析。两个治疗组中的大多数患者都有无法切除的疾病。中位随访期为41个月(19~86个月)。3年后综合治疗组总存活率为55%，超分割组总存活率为34%(P=0.07)。联合治疗组无复发生存率较高(61%比41%，P=0.08)。3年后局部控制率联合治疗组为70%，超分割组为44%(P=0.01)。两组中分别有77%和75%的患者出现融合性粘膜炎。超分割组3例、综合治疗组5例出现严重并发症。结论综合治疗晚期头颈部肿瘤较单纯超分割放疗疗效更好，毒性更小。(C)1998年，马萨诸塞州医学会。
Background Radiotherapy is often the primary treatment for advanced head and neck cancer, but the rates of locoregional recurrence are high and survival is poor. We investigated whether hyperfractionated irradiation plus concurrent chemotherapy (combined treatment) is superior to hyperfractionated irradiation alone.Methods Patients with advanced head and neck cancer who were treated only with hyperfractionated irradiation received 125 cGy twice daily, for a total of 7500 cGy. Patients in the combined-treatment group received 125 cGy twice daily, for a total of 7000 cGy, and five days of treatment with 12 mg of cisplatin per square meter of body-surface area per day and 600 mg of fluorouracil per square meter per day during weeks 1 and 6 of irradiation. Two cycles of cisplatin and fluorouracil were given to most patients after the completion of radiotherapy.Results of 122 patients who underwent randomization, 116 were included in the analysis. Most patients in both treatment groups had unresectable disease. The median follow-up was 41 months (range, 19 to 86). At three years the rate of overall survival was 55 percent in the combined-therapy group and 34 percent in the hyperfractionation group (P=0.07). The relapse-free survival rate was higher in the combined-treatment group (61 percent vs. 41 percent, P=0.08). The rate of locoregional control of disease at three years was 70 percent in the combined-treatment group and 44 percent in the hyperfractionation group (P=0.01). Confluent mucositis developed in 77 percent and 75 percent of the two groups, respectively. Severe complications occurred in three patients in the hyperfractionation group and five patients in the combined-treatment group.Conclusions Combined treatment for advanced head and neck cancer is more efficacious and not more toxic than hyperfractionated irradiation alone. (C) 1998, Massachusetts Medical Society.