| 국소진행 두경부 상피세포암에서 선행화학요법 및 보조화학요법을 포함하는 복합치료요법의 효과 |
| 노재경, 이화영, 정현철, 박용준, 노형근, 서창옥, 김귀언, 노준규, 홍원표, 박정수, 김병수 |
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| Efficacy of Combined Modality , Multidisciplinary Treatment ( Neoadjuvant Chemotherapy , Difinite Local Treatment , and Adjuvant Chemotherapy ) in Locally Advanced Head and Neck Squamous Cell Carcinoma |
| Jae Kyung Roh, Wha Young Lee, Hyun Cheol Chung, Young Joon Park, Hyung Keun Roh, Chang Ok Suh, Gwi Eon Kim, Jun Kyu Loh, Won Pyo Hong, Cheong Soo Park, Byung Soo Kim |
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| ABSTRACT |
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Between January, 1986 and October, 1989, 40 patients with previously untreated, locally advanced head and neck squamous cell carcinoma enrolled for combined modality treatment (CMT) with neoadjuvant chemotherapy (2 cycles of infusional 5-FU and cis-platin), definite local treatment (DLT) (surgery and/or radiotheray) and adjuvant chemotherapy (3 cycles of infusional 5-FU and cis-platin) to enhance the therpeutic efficacy. Of the 40 enrolled, all the patients were evaluable for tumor responses and treatmen#t related toxicities after neoadjuvant chemotherapy, and 35 patients finished scheduled CMT. Male to female ratio were 33:7, median age 54 year old (34-69), and median ECOG performance grade 1 (0-2). Primary sites were nasopharynx 19, oral cavity 16, larynx 3, hypopharynx 1, and maxillary sinus l. After the 2 cycles of neoadjuvnt therpay, 8/40 (20%), 23/40 (72.5%) achieved compIete remission (CR) and partial remission (PR), respectively with 92.5% over all response rates. After the DLT, 23/ 35 (67.5%) 11/35 (31.4%) achieved CR, and PR respectively with 97.1% over all response rates. Of the 35 patients who finished the DLT, 15 received the 3 cycles of adjuvnat chemotherapy with infusional 5-FU and cis-platin. The median failure-free, and overal survival duration of 35 evaluable patients were 21.7 months and 31.0 months, respectively after the CMT. The median survival duration was significantly prolonged in patients with objective respanses after the neoadjuvant chemotherapy compared to those of non-responders (p<0.05). Of the 35 patients who finished the DLT, patients who received the adjuvant chemotherapy showed trend of prolongation of survival when compared to no adjuvant chemotherapy patients Imedian overall survival duration; adjuvant group 21.7 months, no adjuvant group 17.6 month (p>0.05). This study strongly suggests that CMT can increase the median response duration and survival especially in patients with locally advanced head and neck squamous cell carcinoma who showed responses after the neoadjuvant chemotherapy with infusional 5-FU and cis-platin, but phase III randomized controlled prospective studies are warranted for the verification of this study. |
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