• Asian Pacific Journal of Cancer Prevention
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• 제15권10호
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• pp.4147-4152
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• 2014

Standard therapy for advanced head and neck cancer consists of a combination of surgery and radiation. However, survival of this patient population has not improved during the past 20 years. Many different multimodality treatment schedules have been proposed, and chemotherapy is often used with the intent of organ preservation. The present study was intended to establish the efficacy of concomitant chemoradiation with a single agent carboplatin in advanced head and neck cancers.The objectives were to investigate the feasibility of concomitant administration of carboplatin, monitor acute toxicity during radiotherapy, and determine subacute side effects, such as wound healing following surgery after chemoradiotherapy. A prospective study was conducted wherein a total of 40 patients with stage III and IV squamous cell carcinomas of oral cavity, oropharynx, hypopharynx and larynx were enrolled. All patients were treated with external beam radiotherapy and weekly carboplatin area under curve (AUC of 5). Radiotherapy was given in single daily fractions of 1.8-2 grays (Gy) to a total dose of 66-72 Gy. Salvage surgery was performed for any residual or recurrent locoregional disease. Neck dissection was recommended for all patients with neck disease showing less than a complete response after chemoradiation. A total of 40 patients were enrolled of whom 32 were males and 8 were females. Highest incidence of cancer was seen in the 5th-6th decades of life with a median age of 47.7 years. Oropharyngeal tumours constituted a maximum of 21 patients followed by hypopharynx in 10, larynx in 7 and oral cavity in 2. 80% of the patients had a neck node on presentation of which 40% had N2-N3 nodal status. TNM staging revealed that 58% of patients were in stage III and 43% in stage IV. Evaluation of acute toxicity revealed that 50% had grade II mucositis, 25% grade III mucositis, 2.5% grade IV mucositis. 50% of patients had grade I skin reactions, 65% of patients had grade I thrombocytopenia, and 24% of patients had grade I anaemia. After completion of treatment 65% of patients had complete response at the primary and regional sites, and 35% of patients had a partial response of whom 23% underwent neck dissection and 5% of them underwent salvage surgery at the primary site. At the end of one year there were six deaths and four recurrences and 70% were free of disease. Concurrent chemoradiation with carboplatin provided good locoregional control for locally advanced head and neck cancers. This regimen, although toxic, is tolerable with appropriate supportive intervention. Primary site conservation is possible in many patients. Chemoradiotherapy appears to have an emerging role in the primary management of head and neck cancers.

• 대한두경부종양학회지
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• 제23권2호
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• pp.153-156
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• 2007

목적 : 투석을 받고 있는 진행된 두경부암 환자에서 Cisplatin 동시 화학방사선 요법의 타당성과 약물역동학에 대해 연구하였다. 방법 : 57세 말기 신장병을 앓고 있던 남자환자가 임상 병기 3기의 외이도 암을 진단 받고 종양 완전 절제술을 시행하였다. 수술 후 6개월에 환자는 국소 부위 재발하였다. 절단술과 술후 5200cGy, 26fx의 방사선 치료 시행에도 불구하고 다시 국소 부위 재발 보여 3주기동안 Cisplatin 기반의 방사선 화학 병합 요법 치료를 하였다. 총 3주간 Cisplatin $20mg/m^2$를 투여했으며 화학 요법 1일째 30분 동안 Cisplatin을 정주하고 30분 후 혈액투석을 4시간 동안 시행하였다. 화학요법 3일째와 5일째에도 혈액투석을 시행하였다. 환자의 혈장 시료는 Cisplatin 정주 후 특정한 시간에 채취되었다. 결과 : Cisplatin 동시 화학방사선요법 3차 시행 후 환자의 종괴 크기는 현저하게 감소하였다. Cisplatin의 최대 혈장 농도는 총 platinum은 $0.74{\mu}g/ml$였고 free platinum은 $0.37{\mu}g/ml$로 이었다. AUC 값은 총 platinum은 $94.7{\mu}g{\cdot}h/ml$, free platinum은 $11.3{\mu}g{\cdot}h/ml$이었다. 결론 : 투석을 받는 진행된 두경부암 환자에서 Cisplatin 동시 화학방사선요법을 시행한 증례를 보고하며 이들 환자에서 정용량의 Cisplatin 동시 화학방사선요법이 감내할 만하다고 제안한다.