The use of carboplatin and paclitaxel with daily radiotherapy in patients with locally advanced squamous cell carcinomas of the head and neck
The use of carboplatin and paclitaxel with daily radiotherapy in patients with locally advanced squamous cell carcinomas of the head and neck
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DOI：
10.1016/s0360-3016(00)00408-9
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发表时间：
2000-04-01
影响因子：
7
通讯作者：
Van Echo, DA
中科院分区：
文献类型：
--
作者：
Suntharalingam, M;Haas, ML;Van Echo, DA
目的：不可切除的头颈鳞状细胞癌 (SCCHN) 继续构成重大的治疗挑战。本报告定义了与卡铂 (CBDCA)、紫杉醇和每日一次放疗联合治疗局部晚期疾病患者相关的毒性、疗效和预后因素。此外，还研究了紫杉醇的药代动力学。方法和材料：从 1993 年至 1998 年，62 名患有该病的患者接受了治疗。 III-IV SCCHN 用 70.2 Gy 的 RT 以 1.8 Gy/次/天的剂量治疗原发部位。放疗期间每周进行化疗，化疗药物包括紫杉醇（45 mg/m(2)/周）和CBDCA（100 mg/m(2)/周）。所有患者均患有局部晚期疾病； 77% 患有 T4 疾病，21% 患有 T3 疾病，58% 患有 N2b-N3 疾病。 结果：60 名患者可通过中位随访 30 个月（范围 7-70）评估疗效和生存率，98% 的患者完成了处方治疗。一名患者因伪膜性结肠炎拒绝医疗治疗后死亡，毒性评分为 5 级。两名患者患有 4 级白细胞减少症，中位休息天数为 2 天。原发部位的临床完全缓解 (CR) 率为 82%，总（原发部位和颈部）CR 率为 75%，整个队列的中位生存期为 33 个月。对治疗的反应和就诊时颈部的状态是唯一发现影响生存的预后因素。获得 CR 的患者的中位生存期为 49 个月，而未获得 CR 的患者的中位生存期为 9 个月 (p < 0.0001)。完全缓解者的 2 年和 3 年总生存率分别为 79% 和 61%，血浆紫杉醇浓度达到了放射增敏范围。结论：每周给予卡铂和紫杉醇，同时每日一次明确的外照射治疗，耐受性良好，超过 90% 的患者完成了处方治疗。最终 CR 率超过 70%，这直接转化为生存率的提高。该方案整个组的 3 年总生存率为 48%，对于这组历史上预后不良的患者来说是一个极好的选择。 (C) 2000 爱思唯尔科学公司。
Purpose: Unresectable squamous cell carcinomas of the head and neck (SCCHN) continue to pose a significant therapeutic challenge, This report defines the toxicities, efficacy, and prognostic factors associated with the combination of carboplatin (CBDCA), paclitaxel, and once-daily radiation for patients with locally advanced disease, Additionally, the pharmacokinetics of paclitaxel were investigated.Methods and Materials: From 1993-1998, 62 patients with Stage III-IV SCCHN were treated with 70.2 Gy of RT at 1.8 Gy/fraction/day to the primary site. Weekly chemotherapy was given during RT consisting of paclitaxel (45 mg/m(2)/wk) and CBDCA (100 mg/m(2)/wk). All patients presented with locally advanced disease; 77% had T4 disease and 21% had T3 disease, Fifty-eight percent had N2b-N3 disease.Results: Sixty patients were evaluable for response and survival with a median follow-up of 30 months (range 7-70), Ninety-eight percent of patients completed prescribed therapy. One patient died after refusing medical management for pseudomembranous colitis and is scored as a Grade 5 toxicity. Two patients suffered Grade 4 leukopenia, Median number of break days was two. A clinical complete response (CR) at the primary site was obtained in 82%, with a total (primary site and neck) CR rate of 75%, The median survival for the entire cohort is 33 months. Response to therapy and status of the neck at presentation were the only prognostic factors found to influence survival. The median survival for patients who attained a CR is 49 months versus 9 months in those who did not attain a CR (p < 0.0001). The 2- and 3-year overall survival for complete responders are 79% and 61%, Plasma paclitaxel concentrations in the range shown to be radiosensitizing were achieved.Conclusions: Weekly carboplatin and paclitaxel given concurrently with definitive once-daily external beam radiation therapy is well tolerated with over 90% of patients completing prescribed therapy. An ultimate CR rate of greater than 70% was obtained, which translated directly into improved survival. With 48% 3-year overall survival for the entire group, this regimen is an excellent option for this group of patients with a historically poor prognosis. (C) 2000 Elsevier Science Inc.