Maximizing local control and organ preservation in stage IV squamous cell head and neck cancer with hyperfractionated radiation and concurrent chemotherapy
Maximizing local control and organ preservation in stage IV squamous cell head and neck cancer with hyperfractionated radiation and concurrent chemotherapy
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DOI：
10.1200/jco.20.5.1405
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发表时间：
2002-03-01
影响因子：
45.3
通讯作者：
Carroll, MA
中科院分区：
文献类型：
--
作者：
Adelstein, DJ;Saxton, JP;Carroll, MA
目的：报道晚期头颈部鳞状细胞癌的积极放化疗方案。患者和方法：晚期头颈部鳞状细胞癌患者接受超分割放射治疗(72Gy1.2Gy2次/d)和两个疗程的同步化疗：氟尿嘧啶(1,000 mg/m(2)/d)和顺铂(20 mg/m(2)/d)，在放射治疗1周和4周内均连续静脉滴注96小时。原发灶切除用于放化疗后残留或复发的原发灶。无论临床反应如何，对于N2期或以上的疾病，以及非手术治疗后残留或复发的颈部疾病，均可考虑行颈淋巴清扫术。毒性显著，3-4级粘膜炎占98%，吞咽困难占88%，皮肤反应占85%。需要住院的中性粒细胞减少性发热发生率为51%。尽管有35名患者(85%)放置了喂养管，但放化疗期间的平均体重下降为初始体重的13.3%。一名患者在治疗过程中死于肺血栓。在平均30个月的随访期中，Kaplan-Meier预测的3年总存活率为59%，疾病特异性存活率为69%，局部控制率为91%，局部控制率为97%。3年后远处疾病控制的可能性为74%，13例死亡患者中有8例存在远处转移。结论：该放化疗方案产生了相当大但可控的毒性。对于这个预后不良的患者来说，存活和器官保存是非常好的。远处转移是治疗失败的最常见原因。(C)2002年，由美国临床肿瘤学会提供。
Purpose : Results are reported from an aggressive chemoradiotherapy protocol for advanced squamous cell head and neck cancer.Patients and Methods : Patients with advanced squamous cell head and neck cancer were treated with hyperfractionated radiation therapy (72 Gy at 1.2 Gy twice per day) and two courses of concurrent chemotherapy with fluorouracil (1,000 mg/m(2)/d) and cisplatin (20 mg/m(2)/d), both given as 96-hour continuous intravenous infusions during weeks 1 and 4 of radiation therapy. Primary-site resection was reserved for residual or recurrent primary-site disease after chemoradiotherapy. Neck dissection was considered for N2 or greater disease, irrespective of clinical response, and for residual or recurrent neck disease after nonoperative treatment.Results: Forty-one patients with stage IV disease were treated. Toxicity was significant, with grade 3 to 4 mucositis in 98%, dysphagia in 88%, and skin reaction in 85%. Neutropenic fever requiring hospitalization occurred in 51%. Despite feeding tube placement in 35 patients (85%), the mean weight loss during chemoradiotherapy was 13.3% of initial body weight. One patient died during treatment as a result of a pulmonary embolus. At a median follow-up period of 30 months, the 3-year Kaplan-Meier projected overall survival was 59%, disease-specific survival 69%, likelihood of local control without surgical resection 91%, and local control with surgical resection 97%. The likelihood of distant disease control at 3 years was 74%, and distant metastases were present in eight of 13 patients who died.Conclusion: This chemoradiotherapy schedule produces considerable but manageable toxicity. Survival and organ preservation are excellent for this poor-prognosis patient cohort. Distant metastases are the most common cause of treatment failure. (C) 2002 by American Society of Clinical Oncology.