Deutsch
Albanian
Arabic
Armenian
Azerbaijani
Belarusian
Bengali
Bosnian
Catalan
Czech
Danish
Deutsch
Dutch
English
Estonian
Finnish
Français
Greek
Haitian Creole
Hebrew
Hindi
Hungarian
Icelandic
Indonesian
Irish
Italian
Japanese
Korean
Latvian
Lithuanian
Macedonian
Mongolian
Norwegian
Persian
Polish
Portuguese
Romanian
Russian
Serbian
Slovak
Slovenian
Spanish
Swahili
Swedish
Turkish
Ukrainian
Vietnamese
Български
中文(简体)
中文(繁體)
American Journal of Surgery 1995-Nov

Preoperative cisplatin and accelerated hyperfractionated radiation induces high tumor response and control rates in patients with advanced head and neck cancer.

Nur registrierte Benutzer können Artikel übersetzen
Einloggen Anmelden
Der Link wird in der Zwischenablage gespeichert
H J Wanebo
A S Glicksman
C Landman
G Slotman
C Doolittle
J Clark
R J Koness

Schlüsselwörter

Abstrakt

BACKGROUND

Preoperative therapy with concurrent cisplatin infusion and accelerated hyperfractionated radiation has the potential to eradicate pools of resistant cells with high-growth fraction that accumulate during standard radiation therapy. Based on preliminary data showing a high complete response rate (necessary for organ preservation) in patients with advanced squamous cell cancer of the head and neck (stages III and IV), we conducted a multi-institutional study using accelerated hyperfractionated radiation to maximize local and regional tumor control without adding toxicity.

METHODS

Preoperative radiation was given in 1.8 Gy fractions for 2 weeks followed by 1.2 Gy BID hyperfractionation to 46.7 Gy. Continuous infusion of cisplatin 20 mg/m2 was given on days 1 through 4 and 22 through 25. Patients were initially assessed with panendoscopy and were subsequently reassessed with biopsy of primary site (+/- nodes). Patients with negative primary site biopsy received additional hyperfractionated radiation to 76 Gy with simultaneous carboplatin 25 mg/m2 BID for 12 consecutive days. Patients with residual disease after 47 Gy had resection of primary site and node dissection. Of 69 patients treated, 56 were T3 and T4, and 46 were N1, N2, and N3; 17 patients (25%) were stage III and 50 (72%) were stage IV; in 2 patients (3%) the stage was unknown.

RESULTS

Treatment was well tolerated with no grade IV toxicities, but there were 13 patients with grade III toxicities (mucositis, dysphagia, or hematological toxicity). Biopsy specimens were taken from 84% of the patients, and 81% of the primary sites showed pathologic complete response and 49% of the lymph nodes showed a pathologic complete response. Thirty-four patients underwent curative surgery. Eleven required resection of the primary and 23 required neck dissection only. At 2 years (median followup 12 months), 44 of 69 patients (64%) have no evidence of disease, 9 are dead of disease, 9 are dead of other causes, and 6 are alive with disease. Surgical toxicities were minimal and primarily limited to fibrosis in 12 patients, edema in 8 patients, tracheoesophageal fistula in 1 patient, and delayed wound healing in 1 patient. Late toxicities included xerostomia in 22 patients, dysphagia in 17, and speech impairment in 9.

CONCLUSIONS

Preoperative concurrent radiotherapy and chemotherapy provides a high level of organ preservation and local and regional control because of the high complete response rate at the primary site. A planned neck dissection with minimal morbidity ensures local/regional control, as well as providing definitive staging information. A randomized evaluation is suggested for this program.

Treten Sie unserer
Facebook-Seite bei

Die vollständigste Datenbank für Heilkräuter, die von der Wissenschaft unterstützt wird

  • Arbeitet in 55 Sprachen
  • Von der Wissenschaft unterstützte Kräuterkuren
  • Kräutererkennung durch Bild
  • Interaktive GPS-Karte - Kräuter vor Ort markieren (in Kürze)
  • Lesen Sie wissenschaftliche Veröffentlichungen zu Ihrer Suche
  • Suchen Sie nach Heilkräutern nach ihrer Wirkung
  • Organisieren Sie Ihre Interessen und bleiben Sie über Neuigkeiten, klinische Studien und Patente auf dem Laufenden

Geben Sie ein Symptom oder eine Krankheit ein und lesen Sie über Kräuter, die helfen könnten, geben Sie ein Kraut ein und sehen Sie Krankheiten und Symptome, gegen die es angewendet wird.
* Alle Informationen basieren auf veröffentlichten wissenschaftlichen Forschungsergebnissen

Google Play badgeApp Store badge