Is high‐dose intensity intraarterial cisplatin chemoradiotherapy for head and neck carcinoma feasible?
Is high‐dose intensity intraarterial cisplatin chemoradiotherapy for head and neck carcinoma feasible?
复制标题
高剂量强度顺铂动脉内放化疗治疗头颈癌是否可行？
作者：
K. Robbins
在本期中，Foote 等人。报告他们使用高剂量动脉内顺铂化疗和伴随的加速加速放射治疗相结合治疗晚期头颈癌患者的初步经验。他们的结论是这种治疗方式的组合是不可行的。该观察基于 19 名患者，他们每周接受 3 或 4 个周期的 150 mg/m2 顺铂动脉注射，同时接受 15-20 分钟内 9 g/m2 剂量的硫代硫酸钠静脉注射，随后 6 小时内接受 12 g/m2 剂量的硫代硫酸钠静脉注射。所有患者均在 6 周内接受同时、伴随、加强加速放射治疗，其中包括 42 次照射 72 戈瑞 (Gy)。前 15 名入组患者中有 2 名患者死亡，两人均因化疗引起的中性粒细胞减少症继发脓毒症所致。尽管在第二例死亡后将动脉内输注次数从 4 次减少到 3 次，但随后接受修改方案治疗的第四名患者也出现了中性粒细胞减少症、败血症和导致截肢的血栓栓塞事件。这些观察结果使作者得出结论，改变分割放射治疗和动脉内顺铂的组合在所概述的剂量中是不可行的。与这个结论相反，包括我在内的其他人都认为这种治疗方案是可行的。在下面的段落中，我概述了我在管理数百名接受动脉内顺铂治疗的患者时的个人经验，使用的剂量和给药途径与本研究中使用的剂量和途径相似。我还强调了其他研究人员发表的经验，他们都得出结论认为高剂量强度方法是可行且非常有效的。首先，必须问：当可以使用静脉化疗方案时，为什么还要进行动脉化疗？肿瘤学家意识到通过动脉途径进行化疗的药代动力学优势。药物的第一次通过是通过肿瘤床，从而允许高浓度的暴露。头颈部肿瘤患者非常适合动脉化疗，因为其动脉供应容易，且具有头颈部血流较慢的相对优势。第447章 头颈癌的动脉化疗
In this issue, Foote et al. report their preliminary experience in treating patients with advanced head and neck carcinoma using a combination of high-dose intraarterial cisplatin chemotherapy and concomitant, boost-accelerated radiation therapy. They conclude that this combination of treatment modalities is not feasible. This observation is based on 19 patients who received 3 or 4 weekly cycles of intraarterial cisplatin at doses of 150 mg/m and simultaneous received intravenous sodium thiosulfate at a dose of 9 g/m over 15–20 minutes followed by 12 g/m over 6 hours. All patients received concurrent, concomitant, boost-accelerated radiation therapy consisting of 72 grays (Gy) in 42 fractions over 6 weeks. There were 2 patient deaths among the first 15 patients enrolled, both of which resulted from sepsis secondary to chemotherapy-induced neutropenia. Despite reducing the number of intraarterial infusions from four to three after the second death, the fourth patient who was treated subsequently on the modified protocol also developed neutropenia, sepsis, and thromboembolic events leading amputations. These observations led the authors to conclude that the combination of altered fractionation radiation therapy and intraarterial cisplatin in the doses outlined was not feasible. In contrast to this conclusion, others, including me, believe that this treatment regimen is feasible. In the paragraphs below, I have outlined my personal experience in managing hundreds of patients treated with intraarterial cisplatin using the dose and route of administration similar to those used in this current study. I also have highlighted the published experience of other investigators, all of whom concluded that the high-dose-intensity approach is feasible and highly efficacious. First, it must be asked: Why intraarterial chemotherapy when intravenous regimens are available? Oncologists are aware of the pharmacokinetic advantages of administering chemotherapy through an intraarterial route. The first pass of the drug is through the tumor bed, allowing exposure of a high concentration. Patients with head and neck tumors are quite suitable for intraarterial chemotherapy because of easy access to the arterial supply and the relative advantage of the slower blood flow to the head and neck region. Although intraarterial chemotherapy for head and neck carcinoma has been 447