目的:本工作的目的是就全身给药的药物与放射(rt)或手术的组合或顺序使用提出建议,或者两者兼而有之,用于治疗或器官保存,或者两者兼而有之,在头颈部(lascchn)局部晚期非转移性(iii-ivb期)鳞状细胞癌患者中。
方法:头颈部肿瘤化疗的Meta分析(mach-nc)报道,事实上,自2000年以来指导实践,因此我们检索了2000年1月至2015年2月发表的关于五个研究问题的系统综述文献。截至2015年2月,还对未纳入荟萃分析的随机试验(rcts)进行了搜索。建议是使用安大略省癌症护理计划在循证护理实践指南开发周期中构建的。
结果:除了更新的mach-NC报告外,另外5个荟萃分析和30个rcts被确定。基于这些数据产生了5个关于lascchn治疗的建议。当rt用作最终治疗时,建议同时放化疗(ccrt)以最大程度地提高71岁以下患者的治愈机会。同样的建议也适用于切除的lascchn被认为是局部区域复发的高风险患者。对于lascchn患者,他们是器官保存策略的候选人,否则需要全喉切除术,CCRT或诱导化疗,然后是rt或基于肿瘤反应的手术建议。在强化rt中添加西妥昔单抗(伴随加强或超分割时间表)是ccrt的替代方法。不建议常规使用诱导化疗来提高总生存率。
结论:我们能够使用来自接受rt作为确定性或术后治疗的患者的高水平证据,为在lascchn治疗中使用全身疗法提供建议。局限性是缺乏与人乳头瘤病毒相关的口咽癌的分层。一个rct提供了在确定的rt设置中使用西妥昔单抗替代化疗的证据。同步放化疗为喉部保存提供了一种策略,但最好的策略还不清楚。使用诱导化疗并不能提高总生存率,其使用应限于需要在局部治疗前立即缩小肿瘤的患者。
OBJECTIVE: The aim of the present work was to make recommendations about the use of systemically administered drugs in combination or in sequence with radiation (rt) or surgery, or both, for cure or organ preservation, or both, in patients with locally advanced nonmetastatic (stages iii-ivb) squamous cell carcinoma of the head and neck (lascchn).
METHODS: The Meta-analysis of Chemotherapy in Head and Neck Cancer (mach-nc) reports have, de facto, guided practice since 2000, and so we searched the literature for systematic reviews published from January 2000 to February 2015 in reference to five research questions. A search was also conducted up to February 2015 for randomized trials (rcts) not included in the meta-analyses. Recommendations were constructed using the Cancer Care Ontario Program in Evidence-Based Care practice
guidelines development cycle.
RESULTS: In addition to updated mach-nc reports, five additional meta-analyses and thirty rcts were identified. Five recommendations for lascchn treatment were generated based on those data. Concurrent chemoradiation (ccrt) is recommended to maximize the chance of cure in patients less than 71 years of age when rt is used as definitive treatment. The same recommendation also applies to patients with resected lascchn considered to be at high risk for locoregional recurrence. For lascchn patients who are candidates for organ preservation strategies and would otherwise require total laryngectomy, either ccrt or induction chemotherapy, followed by rt or surgery based on tumour response is recommended. The addition of cetuximab to intensified rt (concomitant boost or hyperfractionated schedule) is an alternative to ccrt. Routine use of induction chemotherapy to improve overall survival is not recommended.
CONCLUSIONS: We were able to use high-level evidence from patients receiving rt as definitive or postoperative treatment to generate recommendations for the use of systemic therapy in the treatment of lascchn. A limitation is a lack of stratification for human papillomavirus-related cancers of the oropharynx. One rct provided evidence for the use of cetuximab as an alternative to chemotherapy in the definitive rt setting. Concurrent chemoradiation provides one strategy for larynx preservation, but the best strategy is unclear. Use of induction chemotherapy does not improve overall survival, and its use should be limited to patients requiring immediate tumour downsizing before local therapy.