Současné podávání cisplatiny jednou týdně a radioterapie s modulovanou intenzitou svazku s využitím simultánního integrovaného boostu při léčbě pokročilého skvamocelulárního karcinomu hlavy a krku

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Autoři: P. Dubinský ^1,2; B. Jeremic ³; M. Švajdová ^4,5; G. Barilíková ¹; P. Matula ¹; D. Nadzonová ¹; V. Vojtek ¹
Působiště autorů: Department of Radiation Oncology, East Slovakia Institute of Oncology, Košice, Slovakia ¹; Faculty of Health, Catholic University, Ružomberok, Slovakia ²; School of Medicine, University of Kragujevac, Kragujevac, Serbia ³; Department of Radiation and Clinical Oncology, Central Military Hospital – Teaching Hospital Ružomberok, Slovakia ⁴; Department of Radiation Oncology, Faculty of Medicine, Masaryk University, Masaryk Memorial Cancer Institute, Brno, Czech Republic ⁵
Vyšlo v časopise: Klin Onkol 2022; 35(4): 307-314
Kategorie: Původní práce
doi: https://doi.org/10.48095/ccko2022307

Souhrn

Východiska: Radioterapie lokálně pokročilého karcinomu hlavy a krku představuje velkou klinickou výzvu. Jakákoli intenzifikace léčby s cílem zlepšit léčebné výsledky vede k vyšší toxicitě. Hledání optimálního režimu léčby zahrnujícího konvenční nebo alterovanou frakcionaci radioterapie a dávky a frekvence současně podávané cisplatiny nebo jiných systémových léčiv trvá již několik desetiletí. Cíl: Zhodnotit dlouhodobé výsledky a toxicitu akcelerované chemoradioterapie lokálně pokročilého skvamocelulárneho karcinomu hlavy a krku (locally advanced squamous cell carcinoma of the head and neck – LA SCCHN). Soubor pacientů a metody: Čtyřicet pacientů s LA SCCHN stadií stadia III nebo IVA (7. vydání klasifikace TNM) bylo současně léčeno akcelerovanou radioterapií při celkové dávce 67,5 Gy aplikované v 6 týdnech prostřednictvím radioterapie s modulovanou intenzitou svazku s využitím simultánního integrovaného boostu (simultaneous integrated boost intensity-modulated radiotherapy – SIB IMRT) a cisplatinou podávanou 1× týdně v dávce 40 mg/m². Byly hodnoceny 5leté výsledky léčby a časná i pozdní toxicita. Výsledky: Při mediánu doby trvání follow-up 47,8 měsíce byla 5letá míra lokoregionální kontroly (locoregional control rate – LCR) 56.5 %, 5letá míra distanční kontroly (distant control rate – DCR) 87 %, 5leté přežití bez progrese (progression-free survival – PFS) 37 % a 5leté celkové přežití (overall survival – OS) 45 %. Kumulativní dávka cisplatiny ≥ 200 mg/m² byl podána u 83 % pacientů. Pozdní toxicita stupně ≥ 2 s dietním opatřením byla pozorována u 21 (53 %) pacientů. Přítomnost lidského papilomaviru (human papillomavirus – HPV) určená imunohistochemickým stanovením proteinu p16 byla jediným významným faktorem analýzy 5letých výsledků léčby, přičemž u pacientů s HPV pozitivním orofaryngeálním karcinomem (oropharyngeal cancer – OPC) a ostatními HPV negativními LA SCCHN byly hodnoty LCR 100 vs. 41 % (p < 0,01), DCR 100 vs. 78 % (p = 0,154), PFS 80 vs. 23 % (p = 0,01) a OS 80 vs. 34 % (p = 0,03). Závěr: Vysokému procentu pacientů s LA SCCHN byla podána adekvátní kumulativní dávka cisplatiny podávaná současně při akcelerované radioterapii pomocí SIB IMRT. Tato studie prokázala, že chemoradioterapie s cisplatinou podávanou 1× týdně pacientům s HPV+ OPC vedla k příznivým výsledkům týkajícím se lokální kontroly a přežití.

Klíčová slova:

radioterapie – cisplatina – lidský papilomavirus – nádory hlavy a krku – orofaryngeální karcinom

Zdroje

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