AN ANALYSIS OF INDUCTION AND ADJUVANT CHEMOTHERAPY IN THE MULTIDISCIPLINARY TREATMENT OF SQUAMOUS-CELL CARCINOMA OF THE HEAD AND NECK
AN ANALYSIS OF INDUCTION AND ADJUVANT CHEMOTHERAPY IN THE MULTIDISCIPLINARY TREATMENT OF SQUAMOUS-CELL CARCINOMA OF THE HEAD AND NECK
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DOI：
10.1200/jco.1987.5.1.10
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发表时间：
1987-01-01
影响因子：
45.3
通讯作者：
FREI, E
中科院分区：
文献类型：
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作者：
ERVIN, TJ;CLARK, JR;FREI, E
本研究探讨了联合化疗与手术和/或放疗在晚期III期和IV期头颈部鳞状细胞癌（SCCHN）患者初始治疗中的作用。两个疗程的初始（诱导）顺铂，博莱霉素，甲氨蝶呤与口服钙leucovorin（PBM）的主要目的是增加后续手术和/或放疗的有效性。诱导化疗和局部治疗后，对初始化疗有反应的无病患者进入随机试验或辅助PBM。诱导PBM化疗的反应率为完全反应（CR）率为26%，部分反应（PR）率为52%，总反应率为78%。对诱导PBM的反应与无失败生存率高度相关（P <0.0001）。对潜在的预后因素进行了考克斯多步回归分析。在调整了体力状态、初始肿瘤大小和原发肿瘤部位等重要预后因素后，诱导化疗的反应仍然与生存率的提高独立相关（P = .0002）。辅助化疗的随机试验表明，这种治疗通过减少局部区域失败而显着提高了无失败生存率。辅助化疗的益处在诱导化疗PR的患者中尤其明显（P = .01）。这种多学科方法的毒性是可预测和可接受的。诱导或辅助化疗不影响手术和放疗。化疗可以有利地影响生存率的证据有待于通过一项随机试验来证实这些结果，该试验使用常规手术和/或单纯放疗治疗的对照组患者。
This study examines the role of combination chemotherapy with surgery and/or radiotherapy in the initial treatment of patients with advanced stage III and IV squamous-cell carcinoma of the head and neck (SCCHN). Two courses of initial (induction) cisplatin, bleomycin, and methotrexate with oral calcium leucovorin (PBM) were used with the principal intent of increasing the effectiveness of subsequent surgery and/or radiotherpay. Following induction chemotherapy and local treatment, disease-free patients who had responded to inital chemotherapy were entered into a randomized trial or adjuvant PBM. The response rates to induction PBM chemotherapy were a complete response (CR) rate of 26% and a partial response (PR) rate of 52%, for an overall response rate of 78%. A response to induction PBM was highly correlated with failure-free survival (P < .0001). A Cox multistep regression analysis of potential prognostic factors was performed. After adjusting for the significant prognostic factors of performance status, initial tumor size, and primary tumor site, a response to induction chemotherapy remained independently associated with improved survival (P = .0002). The randomized trial of adjuvant chemotherapy demonstrated that such treatment significantly improved failure-free survival by decreasing local-regional failures. The benefit of adjuvant chemotherapy was particularly evident in patients who had a PR to induction chemotherapy (P = .01). The toxicity of this multidisciplinary approach was predictable and acceptable. Surgery and radiotherapy were not compromised by induction or adjuvant chemotherapy. Definitive evidence that chemotherapy can favorably influence survival awaits confirmation of these results by a randomized trial using a control arm of patients treated with conventional surgery and/or radiotherapy alone.