Superselective mtra-arterial chemotherapy and concurrent radiotherapy for patients with advanced oral cancer

晚期口腔癌患者的超选择性动脉化疗和同步放疗

• 批准号: 10671918
• 负责人: IKEMURA Kunio
• 金额: $ 1.73万
• 依托单位: University of Occupational and Environmental Health
• 依托单位国家: 日本
• 项目类别: Grant-in-Aid for Scientific Research (C)
• 财政年份: 1998
• 资助国家: 日本
• 起止时间: 1998 至 2001
• 项目状态: 已结题
• 来源: https://kaken.nii.ac.jp/grant/KAKENHI-PROJECT-10671918/
• 关键词: oral cancer; superselective intra-arterial infusin; carboplatin; hyperfractionation; UFT(R); complete response; hematological toxicity; intratumoral microvessel count; UFT^<【○!R】>; CBDCAの超選択的動注; 単純分割照射; UFT^<【〇!R】>; 組織学的CR; 腫瘍内血管数; 口腔の進行癌

To avoid or reduce the toxicity of carboplatin infused via the nutrient artery of tumors, the mode of dosage calculation was changed ; that is, it was calculated on the basis of the area under the curve (AUC) using the Calvert formula, instead of use of body surface. Concurrent hyperfractionated radiotherapy (5 days/week in twice-daily fractions of 1.5 Gy, a total dose of 30 Gy) and oral administration of UFT^R (400 - 600 mg/day) during radiotherapy were conducted as well as the previous scheme.Twenty patients with aggressive/advanced oral and oropharyngeal squamous cell carcinoma (T2-4) were enrolled and 18 (90%) patients showed complete response. There was no grade 4 hematological toxicity, and grade 3 hematological toxicity was recognized in 3 (15%) patients. It means that this treatment method allows good control of the primary tumor without severe hematological toxicity. In comparison to supradose (150 mg/m2/week x 4) intra-arterial (EA) cisplatin and concurrent radiotherapy reported by Robbins et al, which is used on world-wide scale, our method does not need pre and posthydration and the neutralizing agent (sodium thiosulfate) for the cisplatin, and IA infusion in this method is one time in most patients and a total irradiation dose is usually about half (30 Gy) that of their method (68-72 Gy).High efficacy at the primary site allows less invasive surgery, because of scar contraction of the region occupied by the tumor, and it contributes to a minimal disturbance of QOL. Moreover, this method made usual neck dissection possible in two cases with the metastatic cervical lymph node adhered to the carotid artery.In the experiment using 26 rabbits, intratumoral microvessel counts strongly correlates to platinum concentration in the tumor (r=.875) and microvessel analysis of the specimen taken from 40 patients suggested that more vascular tumors show better response to chemoradiotherapy.

为了避免或减少卡铂经肿瘤滋养动脉输注的毒性，改变了剂量计算模式;即，使用Calvert公式根据曲线下面积（AUC）计算，而不是使用体表。同时采用超分割放疗（5 d/周，每日2次，每次1.5戈伊，总剂量30戈伊）和UFT^R口服（400 ~ 600 mg/d），共纳入20例侵袭性/晚期口腔和口咽鳞癌（T2-4）患者，18例（90%）完全缓解。无4级血液学毒性，3例（15%）患者发生3级血液学毒性。这意味着这种治疗方法可以很好地控制原发性肿瘤，而不会产生严重的血液学毒性。与超剂量相比（150 mg/m2/周× 4）动脉内（EA）顺铂和同步放射治疗（Robbins et al报道，在世界范围内使用），我们的方法不需要预处理和后处理以及中和剂（硫代硫酸钠）用于顺铂，在这种方法中，IA输注在大多数患者中是一次，并且总辐射剂量通常是其方法的一半（30戈伊（68-72戈伊）。由于肿瘤所占据区域的瘢痕收缩，原发部位的高功效允许较小的侵入性手术，并且其有助于对QOL的最小干扰。此外，这种方法使两例颈淋巴结转移瘤与颈动脉粘连的患者可以进行常规颈清扫术，在使用26只家兔的实验中，肿瘤内微血管计数与肿瘤中铂浓度密切相关（r= 0.875），对40例患者标本的微血管分析表明，血管较多的肿瘤对放化疗的反应更好。

项目成果

Oya, R., Ikemura, K.: "Intra-arterial Chemotherapy in Head and Neck Cancer-Current Results and Future Perspectives-"Eckardt, A. (ed.), Einhorn-Presse Verlag. 183-190 (1999)

Oya, R.，Ikemura, K.：“头颈癌的动脉内化疗——当前结果和未来展望——”Eckardt, A.（编辑），Einhorn-Presse Verlag。

Oya R., Ikemura K.: "Organ and function preserving treatment for locoregionally advanced squamous cell carcinoma of the oral cavity and the oropharynx : Superselective intra-arterial carboplatin infusion with concurrent radiotherapy"Oral Oncology. 5. 225-

Oya R.，Ikemura K.：“口腔和口咽局部晚期鳞状细胞癌的器官和功能保留治疗：超选择性动脉内卡铂输注联合放射治疗”口腔肿瘤学。