Docetaxel-based induction therapy prior to radiotherapy with or without docetaxel for non-small-cell lung cancer

This trial aimed to assess the feasibility and tumour control of concurrent chemoradiotherapy or radiotherapy alone after docetaxel-based induction chemotherapy in locally advanced non-small-cell lung cancer (NSCLC). Patients with stage IIIA/IIIB NSCLC received two 21-day cycles of induction chemotherapy with docetaxel (85 mg m(-2), day 1) plus cisplatin (40 mg m(-2), days 1 and 2). Patients without disease progression on day 43 were randomised to radiotherapy (2 Gy for 5 days week(-1); total 60 Gy) alone or with docetaxel 20 mg m(-2) once weekly every 6 weeks. Of 108 patients who received induction chemotherapy, 104 were evaluable for response. After induction chemotherapy, the overall response rate (ORR) was 44%; 91 (88%) patients had no disease progression and 89 were subsequently randomised to local treatment. After randomised therapy, the ORR was 53% (chemoradiotherapy 58%; radiotherapy 48%). Median survival and time to progression were 14.9 and 7.8 months, respectively, for chemoradiotherapy and 14.0 and 7.5 months, respectively, for radiotherapy. The most common toxicities during induction chemotherapy and randomised therapy were grades 3-4 neutropenia and grade 3 lymphocytopenia, respectively. Docetaxel-cisplatin induction therapy followed by concurrent docetaxel and thoracic radiotherapy is a feasible treatment option, showing good clinical activity and tolerability, for locally advanced NSCLC.     

Phase I study of weekly docetaxel and cisplatin concurrent with thoracic radiotherapy in Stage III non-small-cell lung cancer.

PURPOSE: This is the first report of a Phase I study on concomitant weekly cisplatin and docetaxel chemotherapy with thoracic radiation for Stage III non-small-cell lung cancer (NSCLC). The study objectives were to determine the maximum tolerable dose (MTD) and dose-limiting toxicity (DLT) of docetaxel used in this regimen, and to evaluate the feasibility of weekly concurrent chemoradiotherapy. METHODS AND MATERIALS: Patients with histologically proven and unresectable Stage III NSCLC were the subjects of this study. Cisplatin was administered at a fixed dose of 20 mg/m2, while the dose of docetaxel was increased from 0 to 30 mg/m2 in increments of 10 mg/m2. Chemotherapy was given on the first day of each week for 6 weeks. The primary tumor and regional lymph nodes were irradiated to 54 Gy, followed by an additional 9 Gy boost to the primary tumor, making the total dose 63 Gy at 1.8 Gy/fraction. RESULTS: Sixteen men and 2 women with advanced NSCLC without prior treatment were enrolled. The median age of the group was 58 years (range 49-67). Three patients had Stage IIIa disease and 15 patients had IIIb disease. Dose-limiting Grade 3 esophagitis was encountered at a docetaxel dose level of 30 mg/m2 in 2 of 3 patients. No dose-limiting, nonhematologic toxicity occurred in the other patients and no dose-limiting hematologic toxicity occurred in any patient. CONCLUSION: The treatment schedule for NSCLC was feasible, with the DLT being esophagitis. We determined the recommended dose of docetaxel to be 20 mg/m2 for a Phase II study when combined with weekly cisplatin and concomitant thoracic RT.     

Oral vinorelbine and cisplatin with concomitant radiotherapy in stage III non-small cell lung cancer (NSCLC): a feasibility study

BACKGROUND: Concurrent chemoradiotherapy has improved survival in inoperable stage III non-small cell lung cancer (NSCLC). This phase I trial was performed in order to establish a dose recommendation for oral vinorelbine in combination with cisplatin and simultaneous radiotherapy. PATIENTS AND METHODS: Previously untreated patients with stage IIIB NSCLC received concurrent chemoradiotherapy with 66 Gy and 2 cycles of cisplatin and oral vinorelbine which was administered at 3 different levels (40, 50 and 60 mg/m2). This was to be followed by 2 cycles of cisplatin/ vinorelbine oral consolidation chemotherapy. The study goal was to determine the maximal recommended dose of oral vinorelbine during concurrent treatment. RESULTS: 11 stage IIIB patients were entered into the study. The median radiotherapy dose was 66 Gy. Grade 3-4 toxicity included neutropenia, esophagitis, gastritis and febrile neutropenia. The dose-limiting toxicity for concurrent chemoradiotherapy was esophagitis. 9 patients received consolidation chemotherapy, with neutropenia and anemia/thrombocytopenia grade 3 being the only toxicities. The overall response was 73%. CONCLUSION: Oral vinorelbine 50 mg/m2 (days 1, 8, 15 over 4 weeks) in combination with cisplatin 20 mg/m2 (days 1-4) is the recommended dose in combination with radiotherapy (66 Gy) and will be used for concurrent chemoradiotherapy in a forthcoming phase III trial testing the efficacy of consolidation chemotherapy in patients not progressing after chemoradiotherapy.     

Cisplatin, fluorouracil, and leucovorin induction chemotherapy followed by concurrent cisplatin chemoradiotherapy for organ preservation and cure in patients with advanced head and neck cancer: long-term follow-up.

PURPOSE: The poor functional outcome in patients with advanced head and neck squamous cell carcinoma (HNSCC) with surgery and radiation has led to alternative approaches to advanced disease. We conducted a phase II study of induction chemotherapy followed by concurrent chemoradiotherapy for organ preservation in patients with advanced resectable and unresectable (nasopharyngeal) tumors. PATIENTS AND METHODS: Forty-two patients with stage III to IV resectable HNSCC and nasopharyngeal tumors received induction chemotherapy with two courses of cisplatin (20 mg/m2/d continuous infusion [CI]), fluorouracil (800 mg/m2/d CI), and leucovorin (500 mg/m2/d CI; PFL) for 4 days followed by concurrent therapy with cisplatin (100 mg/m2/d on days 1 and 22) and approximately 70 Gy of external-beam radiotherapy. RESULTS: Response to induction chemotherapy included partial response rate of 52% and complete response rate of 24%. The most common grade 3 or 4 toxicity was neutropenia (59%). After cisplatin chemoradiotherapy the complete response rate was 67%. Toxicities of cisplatin chemoradiotherapy consisted of grade 3 or 4 mucositis (79%) and neutropenia (51%). At a median follow-up of 71.5 months, 43% of the patients are still alive and disease-free. The 5-year progression-free survival (PFS) rate was 60%, and the 2- and 5-year overall survival (OS) rates were 67% and 52%, respectively. Three patients died of second primaries. Late complications of treatment included xerostomia and hoarseness. One patient had persistent dysphagia and required laser epiglotectomy 108 months after treatment. CONCLUSION: Induction chemotherapy with PFL followed by concurrent cisplatin chemoradiotherapy is well tolerated and results in a good likelihood of organ preservation and excellent PFS and OS.     

Phase I/II study of docetaxel and cisplatin with concurrent thoracic radiation therapy for locally advanced non-small-cell lung cancer

Recent studies have suggested the superiority of concomitant over sequential administration of chemotherapy and radiotherapy. Docetaxel and cisplatin have demonstrated efficacy in advanced non-small-cell lung cancer (NSCLC). This study evaluated the safety, toxicity, and antitumour activity of docetaxel/cisplatin with concurrent thoracic radiotherapy for patients with locally advanced NSCLC. Patients with locally advanced NSCLC (stage IIIA or IIIB), good performance status, age or=3 toxicities of 71, 60, 24, and 19%, respectively. Toxicity was significant, but manageable according to the dose and schedule modifications. Dose intensities of docetaxel and cisplatin were 86 and 87%, respectively. Radiotherapy was completed without a delay in 67% of 42 patients. The overall response rate was 79% (95% confidence interval (CI), 66-91%). The median survival time was 23.4+ months with an overall survival rate of 76% at 1 year and 54% at 2 years. In conclusion, chemotherapy with cisplatin plus docetaxel given on days 1, 8, 29, and 36 and concurrent thoracic radiotherapy is efficacious and tolerated in patients with locally advanced NSCLC and should be evaluated in a phase III study.     

Docetaxel,cisplatin and 5-fluorouracil-based induction chemotherapy followed by intensity-modulated radiotherapy concurrent with cisplatin in locally advanced EBV-related nasopharyngeal cancer

BackgroundThis monocentric study evaluates the activity and tolerability of docetaxel (Taxotere), cisplatin and 5-fluorouracil (5-FU) (TPF) induction chemotherapy followed by intensity-modulated radiotherapy (IMRT) concurrent with high-dose cisplatin in Epstein–Barr virus -related locally advanced undifferentiated nasopharyngeal cancer.Patients and methodsWe retrospectively reviewed the records of patients who received induction docetaxel 75 mg/m² and cisplatin 75 mg/m² on day 1, and 5-FU 750 mg/m²/day (96-h continuous infusion). Following induction, patients received full doses of IMRT concurrently with cisplatin 100 mg/m² every 21 days for three cycles.ResultsThirty patients received three TPF cycles (median). Induction was well tolerated; the main toxicity was neutropenia (33%, grade 3–4). During chemoradiotherapy, neutropenia (40%) and mucositis (43%) were the most frequent grade 3–4 adverse events. Mean dose of IMRT was 68.8 Gy. Worst late toxicity was xerostomia. Complete response rate was 93%. At 35 months, two patients had locoregional recurrence, three had distant metastases, and one had both. Three-year progression-free survival and overall survival were 79% [95% confidence interval (CI) 64% to 94%] and 87% (95% CI 74%– to 100%), respectively.ConclusionsIn this high-stage nonendemic cancer population, TPF followed by high-dose cisplatin IMRT was promising; this treatment approach deserves evaluation in randomized trials.     

紫杉醇与多西紫杉醇分别联合顺铂及氟脲嘧啶治疗晚期胃癌的疗效比较

目的比较两种紫杉烷类（紫杉醇、多西紫杉醇）化疗药物分别联合顺铂及氟脲嘧啶治疗晚期胃癌患者的疗效及安全性。方法 48例病理为胃腺癌的Ⅳ期患者,随机分入两组：DCF组25例,TCF组23例。DCF组用药为多西紫杉醇（国产）40mg/m2第1,8天＋氟脲嘧啶500mg/m2第1～5天＋顺铂20mg/m2第1～5天,每三周重复;TCF组用药为紫杉醇（国产）85mg/m2第1,8天＋氟脲嘧啶500mg/m2第1～5天＋顺铂20mg/m2第1～5天,每三周重复。每两周期进行疗效及毒性评价,并进行无疾病进展生存期（PFS）统计。结果 DCF组完全缓解（CR）1例（4.0%）,部分缓解（PR）11例（44.0%）,总有效率48.0%,PFS6.2个月;TCF组CR1例（4.3%）,PR12例（52.2%）,总有效率为56.5%,PFS5.9个月,总有效率、PFS两组差异均无统计学意义。3～4级血液学不良反应：TCF组39.1%,DCF组72.0%,有显著性差异;3～4级非血液学毒性主要为恶心/呕吐,DCF组4例（16.0%）,TCF组5例（21.7%）,差异无统计学意义。其他少见毒性,包括DCF组腹泻1例（4.0%）,TCF组周围神经病变1例（4.3%）。结论紫杉醇与多西紫杉醇联合氟脲嘧啶、顺铂治疗晚期胃癌疗效相近,毒性不尽相同,但均可耐受。     

Phase II study of induction chemotherapy with gemcitabine and vinorelbine followed by concurrent chemoradiotherapy with oral etoposide and cisplatin in patients with inoperable stage III non-small-cell lung cancer

PURPOSE: For locoregionally advanced inoperable non-small-cell lung cancer (NSCLC), concurrent chemoradiotherapy has become a standard therapy. We conducted a Phase II trial to examine the efficacy and toxicity of adding gemcitabine and vinorelbine induction chemotherapy to concurrent chemoradiotherapy with oral etoposide and cisplatin. METHODS AND MATERIALS: Eligibility included inoperable clinical Stage III NSCLC without pleural effusion, ECOG performance status 0-1, and weight loss < or =5%. Induction chemotherapy consisted of three cycles of gemcitabine 1,000 mg/m2 and vinorelbine 30 mg/m2, each given i.v. on Days 1 and 8, every 3 weeks. During once-daily thoracic radiotherapy (1.8 Gy/day, total 63 Gy), two cycles of oral etoposide (100 mg on Days 1-5 and 8-12) plus cisplatin (50 mg/m2 on Days 1 and 8) were given concurrently 4 weeks apart. RESULTS: Between April 2002 and November 2003, 42 patients were enrolled and 40 were included in response and toxicity evaluation. The median age was 59 years and 13 patients had IIIA and 27 had IIIB; 24 had squamous ca, 12 had adenocarcinoma, and 4 had others. Objective tumor responses were obtained in 29 patients (72.5%), including 18 (45.0%) after induction chemotherapy. After a median follow-up of 23.8 months, the median survival time and progression-free survival was 23.2 months and 10.9 months, respectively, with 2-year survival rate of 43.9%. For the patients with supraclavicular nodal involvement, the median survival time was 11.8 months with 2-year survival rate of 16.7%, whereas the corresponding figures were 27.8 months and 52.0%, respectively, for those without supraclavicular nodal involvement. Toxicity of induction chemotherapy was mild and well tolerated. However, concurrent chemoradiotherapy was associated with G3/4 hematologic toxicity in 75.7%, G3 esophagitis in 24.2%, and two treatment-related deaths. There were nonlife-threatening late toxicities in additional 6 patients. CONCLUSIONS: Induction chemotherapy with gemcitabine and vinorelbine followed by concurrent chemoradiotherapy with etoposide and cisplatin showed very promising survival in patients with Stage III NSCLC, especially in those without supraclavicular nodal involvement, which warrants further evaluation.     

Docetaxel and concurrent radiotherapy after two cycles of induction chemotherapy with cisplatin and vinorelbine in patients with locally advanced non-small-cell lung cancer. A phase II trial conducted by the Groupe Francais de Pneumo-Cancerologie (GFPC)

CONTEXT: The most satisfactory treatment for patients with locally advanced non-small-cell lung cancer (NSCLC) is combination chemotherapy-radiotherapy (CT-RT). The optimal treatment modalities remain to be determined. OBJECTIVE: We conducted a multicenter phase II trial of the docetaxel-radiotherapy combination after induction chemotherapy with cisplatin-vinorelbine. The main endpoint was the objective response rate. PATIENTS AND METHODS: Patient with inoperable stage locally advanced NSCLC received induction chemotherapy consisting of two cycles of cisplatin 100 mg/m2 on D1 and vinorelbine 25 mg/m2 on D1, D8, D15 and D22. Patients with responses or stable disease then received concurrent RT-CT consisting of 25 mg/m2/week docetaxel and single-fraction radiotherapy (66 grays (Gy) in 33 fractions) over 6.5 weeks. RESULTS: Fifty-six patients were enrolled from 1 July 2000 to 31 December 2001. Sixteen patients left the trial after induction chemotherapy, eight for progression, five for toxicity, and two for intercurrent events. One patient underwent surgery after induction chemotherapy. In total, 40 of the 56 patients received RT-CT. Twelve (30%) of these 40 patients experienced grade III or IV pulmonary or esophageal toxicity. In the intention-to-treat analysis, the objective response rate was 46.4% (95% CI 33.0-60.2). The median time to progression was 6.2 months [1.1-26.0]. The median survival time was 13 months [0.3-44.9 months]. Nine patients progressed during RT-CT, six with brain metastases. CONCLUSION: Weekly docetaxel with concurrent radiotherapy, following chemotherapy is acceptable. The tumor response rate is moderate. Further trials are required to determine the risk-benefit relationship of this treatment schedule, and the possible benefit of adding other cytotoxic drugs.     

泰索帝联合顺铂治疗蒽环类耐药性晚期乳腺癌28例

目的 观察泰索帝联合顺铂治疗蒽环类耐药性晚期转移性乳腺癌28例的疗效与毒副反应.方法 泰索帝75 mg/m2,静滴,d1;顺铂75 mg/m2,静滴,d2-4,同时给与水化、利尿、止吐以及抗过敏预处理等治疗,21 d为1周期.中位化疗周期数为3个(2～5个)周期.结果 28例均可评价疗效.完全缓解(CR)2例(7.1%),部分缓解(PR)13例(46.4%),稳定(SD)6例(21.4%),进展(PD)7例(25%),总有效(CR PR)15例(53.6%),中位肿瘤进展时间(TTP)5.6个月,1年生存率63.7%.主要毒副反应为骨髓抑制、恶心、呕吐.结论 泰索帝和顺铂联合治疗蒽环类耐药的晚期转移性乳腺癌疗效较好,毒副反应轻,耐受性较好,是蒽环类耐药性乳腺癌的有效治疗方案.     

Ⅲ期非小细胞肺癌多学科综合治疗的临床效果

目的：比较同时放化疗加巩固化疗（CCT）和同时放化疗（CRT）对Ⅲ期非小细胞肺癌的近远期疗效及不良反应.方法：57例Ⅲ期非小细胞肺癌分为2组,CRT组（28例）采用多西他赛和顺铂每周化疗同时放疗,放疗采用三维适形放疗,化疗采用多西他赛30mg/m2和顺铂20mg/m2,每周重复,共5周,CCT组（29例）先按CRT组方案治疗结束后再加用多西他赛75mg/m2和顺铂75mg/m2巩固化疗,每3周重复,共2周期.结果：CCT组和CRT组有效率分别为68.9%和53.6%,1、2、3年生存率及中位生存期CCT组分别为64.5%、36.2%、17.3%和18个月,CRT组为48.6%、21.2%、10.7%和13个月,有统计学差异.两组不良反应CCT组血液学毒性较CRT组明显.结论：Ⅲ期非小细胞肺癌患者同期放化疗后巩固性化疗可提高近期疗效、中位生存期,含紫杉类与顺铂的化疗方案可认为是最佳的选择,但其不良反应也明显增加,作为标准治疗仍需临床试验证实.     

Low-Dose Docetaxel/Cisplatin - Leucovorin and 46 Hour Infusional Fluorouracil in Metastatic Gastric Carcinoma

Background: Phase II and III trials of docetaxel, cisplatin and fluorouracil (DCF) have shown superiorefficacy versus cisplatin and fluorouracil alone but with high rates of hematologic toxicity in metastatic gastriccancer cases. To reduce toxicity while maintaining the efficacy of DCF, we investigated low dose docetaxel (D),cispatin (C) - leucovorin and fluorouracil (De Gramont regimen). Patient and methods: Chemotherapy-naïvepatients with metastatic gastric cancer (MGC) received D 60 mg/m2 on day 1 and cisplatin 30 mg/m2 on day 1-2and the De Gramont regimen (Folinic acid 400 mg/m2 on day 1 and 5-FU 2400 mg/m2/46h continuous infusion)every 3 weeks. The primary endpoint was response rate. Results: One hundred twenty patients with a medianage of 52.5 years (range, 32-78) received a median of 6 cycles (range, 2-12 cycles). Of the 120 evaluable patients,4 showed complete remission and 36 achieved a partial response. The overall response rate was 56.6%. Twentyeight patients (23.3%) showed stable disease and 52 (43.3%) progression. The median time to progression was7 months (95%CI 6-7.9). The median overall survival was 15 months (95%CI 13.7-16.2). The most frequenthematological toxicity was leucopenia, which occurred at grade ¾ intensity in 24 patients (20%). Conclusions:Low-dose DC- De Gramont regimen is active in MGC with a tolerable toxicity profile.     

顺铂或多西紫杉醇同期放化疗治疗局部晚期宫颈癌疗效分析

目的：比较顺铂或多西紫杉醇同期放化疗治疗局部晚期宫颈癌疗效。方法：38例IIb到IVa期患者随机分为每周顺铂同期放化疗组（22例）或多西紫杉醇同期放化疗组（16例）。顺铂30mg/m2或多西紫杉醇25mg/m2抗过敏预处理,每周放疗的第一天同步静脉滴注,连续6周;放疗方法：两组患者外照射放疗采用直线加速器盆腔大野DT 30Gy后中央挡铅改为盆腔四野加量照射至DT 50Gy,常规分割,180-200cGy/F,盆腔四野照射期间每周局部后装铱192照射一次,每次剂量6Gy,共6次,A点剂量达3600cGy。观察两组治疗效果和不良反应并进行比较。结果：两组患者总有效率82%vs 87%,临床获益率91%vs 94%,差异无统计学意义（P〉0.05）;两组随访1年无进展生存率（PFS）比较77%vs 81%,总生存率（OS）95%vs 100%,差异无统计学意义（P〉0.05）;但多西紫杉醇同期放化组较顺铂同期放化组治疗无论在血液系统不良反应和非血液系统不良反应方面都明显降低,统计学比较差异有显著性P〈0.05。结论：多西紫杉醇同期放化疗可取得不亚于顺铂同期放化治疗的疗效,且多西紫杉醇不良反应明显降低。     

调强放疗联合培美曲塞和顺铂同期化疗局部晚期非小细胞肺癌的临床研究

目的 探讨调强放疗结合培美曲赛和顺铂同期化疗局部晚期非小细胞肺癌的疗效及副反应.方法 42例Ⅲ期非小细胞肺癌患者(ⅢA期25例,ⅢB期17例)接受DT66 Cy调强放疗,疗中给予培美曲塞500 mg/m2静脉滴注第1天,顺铂75 mg/m2静脉滴注第1天,21 d为1个周期,共4个周期.放化疗在同大开始进行,先化疗后放疗.2例放疗总量54 Gy,2例56 Gy;3例完成了2周化疗,1例完成了 3周化疗.结果 34例患者完成了治疗计划.全组总有效率为79%,1年总生存率为65%.≥3级骨髓抑制2例,3级放射性食管炎3例,≥2级放射性肺炎4例,3级黏膜炎1例.结论 培美曲赛和顺铂同期放化疗局部晚期非小细胞肺癌患者具有较好的近期疗效,副反应可耐受.

Abstract：

Objective To observe the therapeutic effect and toxicity of chemoradiation of locally advanced non-small cell lung cancer by intensity modulated irradiation combined with pemetrexed and cisplatin. Methods Fourty-two patients presented with Ⅲ - stage non-small cell lung cancer(Ⅲ、 25 patients, ⅢB 17 patients)received concurrent chemoradiotherapy. Intensity modulated irradiation technique was used to the total dose of 66 Gy and concurrent chemotherapy consisted of pemetrexed 500 mg/m2 on Day 1 and cisplatin 75 mg/m2 on Day 1 by intravenous infusion once every 3 weeks at the initiation of radiation.Patients received 4 cycles of chemotherapy. Results Thirty-four patients finished the whole of therapeutic schedule. And 2 patients received radiation with total dose of 54 Gy, 2 patients 56 Gy;3 patients received 2 cycles of chemotherapy, 1 patients 3 cycles of chemotherapy. Total effective rate was 79%. There were 2 patients with ≥3 grade marrow depression, 3 patients with 3 grade radiation esophagitis, 4 patients with ≥2 radiation pneumonitis, and 1 patient with 3 grade mucositis. The 1-year survival rate was 65%.Conclusion Recent effect was favourable and toxicity was tolerable for chemoradiation of locally advanced non-small cell lung cancer by intensity modulated irradiation combined with pemetrexed and cisplatin.     

Prospective pilot study of consolidation chemotherapy with docetaxel and cisplatin after concurrent chemoradiotherapy for advanced head and neck cancer

PURPOSE: With the improvement concurrent chemoradiotherapy (CCRT) in the management of patients with locoregionally advanced head and neck squamous cell carcinoma (HNSCC), distant failures have become a more relevant problem in terms of survival. The primary objective of this Phase II study is to assess the feasibility of docetaxel and cisplatin consolidation after primary CCRT for patients with HNSCC. METHODS AND MATERIALS: Patients with locoregionally advanced HNSCC received chemotherapy with three cycles of cisplatin, 100 mg/m(2), on Days 1, 22, and 43. Concurrent radiotherapy to the primary tumor and neck was given in a daily dose of 2 Gy to a total dose of 70-70.2 Gy over 7 weeks. After completion of CCRT, patients without evidence of disease progression received an additional four cycles of consolidation chemotherapy with docetaxel, 75 mg/m(2), and cisplatin, 75 mg/m(2), every 3 weeks. RESULTS: Of 33 patients, 27 (81%) completed CCRT. After CCRT, three complete and 19 partial responses were recorded, giving an overall response rate of 67%. Of 19 patients who went to the consolidation phase, only 4 (21%) received all four cycles of docetaxel and cisplatin. Causes of failure of consolidation chemotherapy were toxicity in 11 patients, including three treatment-related deaths, and progression in 4 patients. Three patients died of sepsis during the consolidation phase. Median survival was 11 months for all patients and 8 months for those treated with consolidation chemotherapy. CONCLUSION: The poor compliance and high incidence of severe toxicities prompted no further evaluation of this consolidation chemotherapy after CCRT.     

Comparison of induction chemotherapy with docetaxel, cisplatin, and 5-fluorouracil (TPF) followed by radiation vs concurrent chemoradiotherapy with TPF in patients with locally advanced squamous cell carcinoma of the head and neck

AimsTo compare the effectiveness of induction chemotherapy with docetaxel, cisplatin and 5-fluorouracil (TPF) followed by radiation with that of concurrent chemoradiotherapy with TPF in patients with locally advanced squamous cell carcinoma of the head and neck (SCCHN).Materials and methodsIn a group of patients receiving induction chemotherapy followed by radiation, 15 patients received two cycles of chemotherapy with docetaxel 60 mg/m², cisplatin 70 mg/m² and 5-day 5-fluorouracil (5-FU) 750 mg/m²/day. Radiotherapy was begun 21 days after completing chemotherapy. In the group receiving concurrent chemoradiotherapy, 19 patients received two cycles of chemotherapy with docetaxel 50 mg/m², cisplatin 60 mg/m², and 5-day 5-FU 600 mg/m²/day. Radiation was begun on the first day of chemotherapy. The total radiation dose was between 63 and 74 Gy.ResultsOverall response rate (partial and complete response — both 100%) and complete response rate (87% and 84%) were similar, but, in overall survival, concurrent chemoradiotherapy with TPF was better than induction chemotherapy with TPF followed by radiation. Mucositis and anaemia were more frequent in the group receiving concurrent chemoradiotherapy, but the group receiving concurrent chemoradiotherapy with TPF improved overall survival.ConclusionsThis is a small non-randomised comparison. The effectiveness of concurrent chemoradiotherapy with TPF was better than that of induction chemotherapy with TPF followed by radiation.     

多西他赛和顺铂同步放化疗治疗局部晚期鼻咽癌临床观察

目的观察局部晚期鼻咽癌同步放化疗的疗效及毒副反应。方法 70例局部晚期鼻咽癌,采用静脉化疗2周期,化疗方案：多西他赛75 mg/m2,分于第1,8天给药;顺铂（DDP）25 mg/（m2.d）d1-3天,21天为1周期。同时给予同步放疗,鼻咽部原发灶给予6 MV-X线和15 MV-X线DT 70 Gy～78 Gy/7-8周。结果 70例中CR 20例,PR 37例,总有效率81.4%。1年、3年生存率分别为98.4%、83.9%。主要毒副反应为骨髓抑制、急性口腔黏膜炎、恶心呕吐、皮肤反应。结论多西他赛和顺铂同步放化疗治疗局部晚期鼻咽癌疗效较好,毒副反应可以耐受。     

Efficacy and Safety of Concomitant Chemoradiotherapy with Cisplatin and Docetaxel in Patients with Locally Advanced Squamous Cell Head and Neck Cancers

Background: Chemoradiation (CRT) using cisplatin-based regimens has become the standard of care in thetreatment of squamous cell head and neck cancers (SCHNC). The impact of taxanes as radiosensitizing agentswith concurrent CRT regimens is unknown. We therefore retrospectively evaluated the efficacy and tolerabilityof a weekly cisplatin+docetaxel combination with CRT in locally advanced SCHNC. Methods: Sixty-six patientswith locally advanced SCHNC (39.4% stage IV, 53% stage III, and 7.6% stage II) were assessed retrospectively.Total radiation dose to the PTV of gross disease (primary and/or node) was 70 Gy/ 35 fractions, 5 fractions perweek. Minimum doses of 60 Gy and 50 Gy were administered to PTVs of elective high risk and low risk disease,respectively. Chemotherapy (CT) consisted of weekly cisplatin (20 mg/m2)+docetaxel (20 mg/m2) concurrentlywith RT. Results: The median age of the patients was 58 years (range, 32-77). Objective response rate was 83.3%.The 2-year progression-free survival (PFS) and overall survival (OS) were 75.7% and 78.3%, respectively.The most common grade 3 and 4 toxicities were mucositis (36.4%), nausea and vomiting (12.1%), neutropenia(4.5%). Conclusion: Weekly cisplatin and docetaxel concurrent with RT for locally advanced SCHNC was foundtolerable with high efficacy.     

多西紫杉醇联合顺铂治疗蒽环类耐药的晚期乳腺癌

Objective： To observe the effect and toxicity of docetaxel with cisplatin in anthracyclines-resistant advanced breast cancer. Methods： Forty-five female patients received docetaxel 60 mg/m^2 on dl and cisplatin 30 mg/m^2 on d1-d3 of every 28 days. Every patient was treated with at least 2 cycles and a median of 3 cycles （2-6 cycles ）. Results： Five patients achieved complete response （11.1%） and 18 partial response （40.0%）, 10 stable disease （22.2%）. The overall response rate was 51.1%. The clinical disease control rate was 73.3%, median time to tumor progression （TTP） was 7.8 months （1.0-34.5 months）, median survival time was 17.6 months （range 1.9-48.0 months）, and one year survival rate was 65.2%. The main side effect was marrow suppression. The treatment was well tolerated with grades Ⅲ and Ⅳ leukopenia in nine （20%） and ten （22.2%） patients. Conclusion： Combinative chemotherapy of docetaxel and cisplatin has a good anti-tumor activity on refractory advanced breast cancer with manageable toxicity.     

多西紫杉醇联合顺铂治疗晚期非小细胞肺癌的疗效

目的评价多西紫杉醇联合顺铂治疗晚期非小细胞肺癌的疗效及不良反应,探讨影响化疗后生存的临床因素。方法病理学确诊的晚期非小细胞肺癌患者41例,给予多西紫杉醇75mg/m2静脉滴注,第1天,顺铂75mg/m2静脉滴注,第2~4天,21天为一个周期,完成两个周期以上化疗的患者评价疗效及不良反应。采用Kaplan-Meier法分析生存情况,Log-rank法进行单因素检验,Cox回归进行多因素分析。结果总有效率为29.3%,中位生存期10.3月。主要不良反应为骨髓抑制、恶心呕吐及脱发,大多数患者耐受性良好。单因素检验及Cox回归分析均显示：对于体能状态评分较好的患者（PS≤2分）,影响生存期的主要因素有TNM分期、体重减轻及化疗疗效（P<0.05）,而与患者的性别、年龄、病理类型关系不大（P>0.05）。结论多西紫杉醇联合顺铂治疗晚期非小细胞肺癌疗效好,不良反应小,耐受性较好,值得临床进一步研究应用,而化疗的疗效,肿瘤的TNM分期及体重减轻均对患者的预后有着重要的影响。