RELEVANCE OF TUMOR SIZE AND CELL-KINETICS AS PREDICTORS OF RADIATION RESPONSE IN HEAD AND NECK CANCER - RANDOMIZED STUDY ON EFFECT OF INTRA-ARTERIAL CHEMOTHERAPY FOLLOWED BY RADIOTHERAPY
RELEVANCE OF TUMOR SIZE AND CELL-KINETICS AS PREDICTORS OF RADIATION RESPONSE IN HEAD AND NECK CANCER - RANDOMIZED STUDY ON EFFECT OF INTRA-ARTERIAL CHEMOTHERAPY FOLLOWED BY RADIOTHERAPY
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DOI：
10.1002/1097-0142(197803)41:3
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发表时间：
1978-01-01
期刊：
影响因子：
6.2
通讯作者：
STARACE, G
中科院分区：
文献类型：
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作者：
NERVI, C;ARCANGELI, G;STARACE, G
原发肿瘤的大小和范围影响其对照射的反应。为了研究这一说法的相关性，进行了一项随机研究，将晚期头颈部癌的放射治疗与联合治疗进行比较，联合治疗采用放射前动脉内化疗来减少肿瘤的范围。对72例口腔、口咽、上颌窦病变患者行动脉化疗（MTX[甲氨蝶呤]3-5 mg/天，疗程25-35天）。根据患者的反应进行再治疗并接受放疗。在随机分配的其他68例中，仅给予相同方式和技术的放射治疗。化疗后，口腔内癌21例，上颌窦癌和口咽癌14例（治疗前分别为0例和23例）分为I期和II期。经过4年的随访，结果显示，在口腔癌的联合治疗中，通过外部和间质技术相结合的放射治疗，局部控制和生存率在统计学上更好。在其他情况下，没有发现统计学上的显著差异。口腔疗效的改善可归因于放疗前化疗获得的肿瘤缩小而更多地使用间质照射，而不是药物和照射之间的某种协同作用。对8例患者进行了肿瘤细胞动力学研究，并测量了细胞核DNA含量，但即使根据肿瘤的临床生长特征进行分组，也没有任何动力学参数与治疗反应相关。头颈癌放疗的后期结果可能取决于某些耐药成分的存在，而这些耐药成分无法通过细胞动力学或细胞核DNA含量来预测。手术切除或第二个疗程的化疗必须被视为多模式治疗的一部分。
Size and extent of a primary tumor influences its response to irradiation. To investigate the relevance of this statement a randomized study was done in which irradiation of advanced carcinoma of head and neck was compared with combined treatment where preirradiation intraarterial chemotherapy was administered to reduce the extent of the tumor. Intraarterial chemotherapy (MTX [methotrexate] 3-5 mg/day for 25-35 days) was given to 72 patients with lesions in the oral cavity, oropharynx and maxillary antrum. Depending on response the patients were restaged and submitted to radiotherapy. In 68 other cases randomly allocated, radiotherapy only was given with the same modality and technique. After chemotherapy 21 cases with intraoral and 14 cases with maxillary antrum and oropharynx cancers were classified as stage I and II (0 and 23, respectively, before treatment). Results after 4 yr follow-up showed local control and survival statistically better in the combined treatment in intraoral cancer where irradiation was delivered by a combination of external and interstitial technique. In the other cases no statistically significant difference was found. Amelioration of the results in the oral cavity could be ascribed to the greater use of interstitial irradiation due to tumor shrinkage obtained with preirradiation chemotherapy more than to some synergistic effect between drug and irradiation. In 8 cases tumor cell kinetics were performed and the nuclear DNA content was measured, but none of the kinetic parameters could be correlated with the response to treatment, even when the cancers were grouped according to their clinical growth characteristics. Late results in the irradiation of head and neck cancer probably depends on the presence of some resistant component, which cannot be predicted by the cell kinetic or nuclear DNA content. Surgical excision or a 2nd course of chemotherapy must be considered as part of multimodality treatment.