頭頸部進行癌に対する放射線治療後の adjuvant chemotherapy (Nedaplatin/UFT) の検討 ADJUVANT CHEMOTHERAPY (NEDAPLANTIN/UFT) AFTER RADIOTHERAPY FOR LOCALLU ADVANCED HEAD AND NECK CANCER
前治療のない頭頸部進行扁平上皮癌の放射線治療の40例 (stage III: 6例, IV: 34例, resectable: 26例, unresectable: 10例, inoperable: 4例) に外来で Nedaplatin を80mg/m<sup>2</sup>で4週ごとに6コースと, UFTEは400mg/日を1年間連日投与の adjuvant chemotherapy を行った。Grade 3以上の毒性は白血球減少で23.1%に, 血小板減少は7.7%に認めた。胃潰瘍で1例が死亡した。計画どおりに施行できたのは25例 (62.5%) であった。2年生存率は stage IIIが100%, IVは61.1%で, 2年 progression free survival (PFS) は stage IIIは83.3%, IVは46.1%であった。放射線のCRの12/14例 (85.7%) と, PRの14/22例 (63.6%) で, adjuvant chemotherapy 中も放射線の効果が持続した。これらの放射線の効果が持続したPRの2年PFSは81.3%とCRの81.8%と差を認めなかった。遠隔転移は2.5%に認めた。本療法は外来投与可能で遠隔転移の抑制が期待できる。
To evaluate the toxicity and efficacy of adjuvant chemotherapy after radiotherapy for patients with locally advanced head and neck squamous cancer, 40 patients, previously untreated (6 with stage III and 34 with stage IV; 26 with resectable, 10 with unresectable and 4 patients with inoperable) were treated with radiotherapy followed by adjuvant chemotherapy (Nedaplatin/UFT) at our outpatient clinic. The primary site was identified in the larynx or hypopharynx in 15, oral cavity or oropharynx in 11, sinuses in 6, nasopharynx in 4, unknown primary in 3, and parotis in 1 patient. Treatment consisted of 6 courses of Nedaplatin 80mg/m<sup>2</sup> repeated at 4 weeks intervals, and one-year oral administration of UFTE 400mg/day, after radiotherapy. Toxicities included leukopenia (grade 3, 20.5%, grade 4, 2.6%), thrombocytopenia (grade 3, 7.7%). There was one death due to gastric ulcer. Twenty-five patients (62.5%) received 6 courses of adjuvant chemotherapy. Two-year overall survival rate was 100% for stage III and 61.1% for stage IV. Over the same period, the progression-free survival rate was 83.3% for stage III and 46.1% for stage IV. 85.7% of CR (12/14 patients) and 63.6% of PR (14/22 patients) to radiotherapy showed that the effect of radiotherapy was maintained during adjuvant chemotherapy. If the effect of radiotherapy was maintained during adjuvant chemotherapy, the two-year progression free survival rate was not different between 81.8% for CR to radiotherapy and 81.3% for PR. The rate of distant failure was 2.5%, which was lower than that citedin previous reports. This adjuvant chemotherapy regimen is tolerable at outpatient clinics and might suppress distant metastasis after radiotherapy.
頭頚部腫瘍 29(1), 166-172, 2003-03-25
Japan Society for Head and Neck Cancer