耳鼻咽喉科・頭頸部外科86巻10号

2014年09月発行

特集 咽頭癌・頸部食道癌の治療戦略Update

≪放射線療法と薬物療法≫

過去の臨床試験から咽頭癌・頸部食道癌の新しい放射線治療の意義と問題点を考える

著者： 久保田彰¹

所属機関： ¹神奈川県立がんセンター頭頸部外科

ページ範囲：P.820 - P.827

文献概要

POINT

現在明らかになっている咽頭癌・頸部食道癌に対する放射線治療の意義と問題点を示す。

●咽頭癌，頸部食道癌の標準治療に組み入れられている放射線治療は，導入化学療法に奏効後の放射線と化学放射線同時併用療法である。

●非通常分割照射は標準分割照射よりloco-regional control率が向上する。

●化学放射線同時併用療法，非通常分割照射は標準分割照射より急性有害事象を増強する。

●強度変調放射線治療は耳下腺線量を減量して口腔乾燥を軽減する。さらに嚥下機能に関連する部位の線量を減量して遅発性嚥下障害を軽減する可能性がある。

●標準分割照射の化学放射線同時併用療法の治療効果が最も高い。

参考文献

1）Lefebvre JL, et al：for the EORTC head and neck cancer cooperative group. J Natl Cancer Int 88：890-899, 1996

2）Al-Sarraf M, et al：Chemoradiation versus radiationtherapy in patients with advanced nasopharyngeal cancer：phase Ⅲ randomized intergroup study 0099. J Clin Oncol 16：1310-1317, 1998

3）Denis F, et al：Final results of the 94-01 French head and neck oncology and radiotherapy group randomized trial comparing radiotherapy alone with concomitant radiochemotherapy in advanced-stage oropharynx carcinoma. J Clin Oncol 22：69-76, 2004

4）NCCN

5）Bosset JF, et al：Chemoradiotherapy followed by surgery compared with surgery alone in squamous-cell cancer of the esophagus. N Engl J Med 337：161-167, 1997

6）Minsky BD, et al：INT 0123（Radiation Therapy Oncology Group 94-05）phase Ⅲ trial of combined-modality therapy for esophageal cancer：high-dose versus standard-dose radiation therapy. J Clin Oncol 20：1167-1174, 2002

7）Fu KK, et al：A radiation therapy oncology group（RTOG）phase Ⅲ radomized study to compare hyperfractionation and two variants of accerated fraction to standard fraction radiotherapy for head and neck squamous cell carcinoma：first report of RTOG 9003. Int J Radiat Oncol Biol Phys 48：7-16, 2000

8）Poulsen MG, et al：A randomized trial of accelerated and conventional radiotherapy for stage Ⅲ and Ⅳ squamous carcinoma of the haed and neck：a trans-tasman radiation oncology group study. Radiother Oncol 60：113-122, 2001

9）Overgaard J, et al：Five compared with fraction per week of conventional radiotherapy of squamous-cell carcinoma of head and neck：DAHANCA 6 & 7 randomised controlled trial. Lancet 362：933-940, 2003

10）Bourhis J, et al：Phase Ⅲ randomized trial of very accelerated radiation therapy compared with conventional radiation therapy in squamous cell head and neck cancer：A GORTEC trial. J Clin Oncol 24：2873-2878, 2006

11）Bourhis J, et al：Hyperfractionated or accelerated radiotherapy in head and neck cancer：a meta-analysis. Lancet 368：843-854, 2006

12）Saunders MI, et al：for the CHART trial collaborators. Mature results of a randomized trial of accelerated hyperfractionnated versus conventional radiotherapy in head-and-neck cancer. Int J Radiation Oncology Biol Phys 77：3-8, 2010

13）Skladowski K, et al：Radiation-free weekend rescue! Continuous accelerated irradiation of 7-days per week is equal to accelerated fractionation with concomitant boost of 7 fractions in 5-days per week：report on phase 3 clinical trial in head-and-neck cancer patients. Int J Radiation Oncol Biol Phys 85：741-746, 2013

14）Wendt TG, et al：Simultaneous radiochemotherapy versus radiotherapy alone in advanced head and neck cancer：a randomized multicenter study. J Clin Oncol 16：1318-1324, 1998

15）Staar S, et al：Intensified hyperfractionated accelerated radiotherapy limits the additional benefit of simultaneous chemotherapy—results of a multicentric randomized german trial in advanced head-neck cancer. Int Radiation Oncology Biol Phys 50：1161-1171, 2001

16）Budach V, et al：Hyperfractionated accelerated chemoradiation with concurrent fluorouracil-mitomycin is more effective than dose-escalated hyperfractionated accelerated radiation therapy alone in locally advanced head and neck cancer：final results of the radiotherapy cooperative clinical trials group of the German cancer society 95-06 prospective randomized trial. J Clin Oncol 23：1125-1135, 2005

17）Bensadoun B-J, et al：French multicenter phase Ⅲ randomized study testing concurrent twice-day radiotherapy and cisplatin/5-fluorouracil chemotherapy（BiRCF）in unresectable pharyngeal carcinoma：results at 2 years（FNCLCC-GORTEC）. Int J Radiation Oncology Biol Phys 64：983-994, 2006

18）Semrau R, et al：Efficacy of intensified hyperfractionated and accelerated radiotherapy and concurrent chemotherapy with carboplatin and 5-fluorouracil：updated results of a randomized multicentric trial in advanced head-and-neck cancer. Int J Radiation Oncology Biol Phys 64：1308-1316, 2006

19）Lee NY, et al：A comparison of intensity-modulated radiation therapy and concomitant boost radiotherapy in the setting of concurrent chemotherapy for locally advanced oropharyngeal carcinoma. Int J Radiat Oncol Biol Phys 66：966-974, 2006

20）Kam MKM, et al：Prospective randomized study of intensity-modulated radiotherapy on salivary gland function in early-stage nasopharyngeal carcinoma patients. J Clin Oncol 25：4873-4879, 2007

21）Nutting CM, et al：Parotid-sparing intensity modulated versus conventional radiotherapy in head and neck cancer（PARSPORT）：a phase 3 multicentre randomized controlled trial. Lancet Oncol 12：127-136, 2011

22）Fang EM, et al：Quality of life and survival outcomes for patients with nasopharyngeal carcinoma receiving three-dimensional conformal radiotherapy versus intensity-modulated radiotherapy—a longitudinal study. Int J Radiat Oncol Biol Phys 72：356-364, 2008

23）Vergeer MR, et al：Intensity-modulated radiotherapy reduces radiation-induced morbidity and improves health-related quality of life：results of a nonrandomized prospective study using a standardized follow-up program. Int J Radiat Oncol Biol Phys 74：1-8, 2009

24）Kouloulias V, et al：The treatment outcome and radiation-induced toxicity for patients with head and neck carcinoma in the IMRT era：a systemic review with dosimetric and clinical parameters. Biomed Res Intl 2013；2013：401261

25）Smith RV, et al：Decreased short-and long-term swallowing problems with altered radiotherapy dosing used in an organ-sparing protocol for advanced pharyngeal carcinoma. Arch Otolaryngol Head Neck Surg 130：831-836, 2004

26）Eisbruch A, et al：Dysphagia and aspiration after chemoradiotherapy for head-and-neck cancer：which anatomic structures are affected and can they be spared by IMRT? Int J Radiation Oncology Biol Phys 60：1425-1439, 2004

27）Feng FY, et al：Intensity-modulated radiatiotherapy of head and neck cancer aiming to reduce dysphagia：early dose-effect relationships for the swallowing structures. Int J Radiation Oncology Biol Phys 68：1289-1298, 2007

28）Christianen MEMC, et al：Predictive modelling for swallowing dysfunction after primary（chemo）radiation：results of a prospective observational study. Radiother Oncol 105：107-114, 2012

29）Duprez F, et al：Systematic review of dose-volume correlates for structures related to late swallowing disturbances after radiotherapy for head and neck cancer. Dysphagia 28：337-349, 2013

30）Ang KK, et al：Human papilloma virus and survival of patients with oropharyngeal cancer. N Engl J Med 363：24-35, 2010

31）Bourhis J, et al：Concomitant chemoradiotherapy versus acceleration of radiotherapy with or without concomitant chemotherapy in locally advaced head and neck carcionoma（GORTEC 99-02）：an open-label phase 3 randomised trial. Lancet Oncol 13：145-153, 2012

32）Prades JM, et al：Randomized phase Ⅲ trial comparing induction chemotherapy followed by radiotherapy to concomitant chemoradiotherapy for laryngeal preservation in T3M0 pyriform sinus carcinoma. Acta Oto-Laryngologica 130：150-155, 2010

33）Haddad R, et al：Induction chemotherapy followed by concurrent chemoradiotherapy（sequential chemoradiotherapy）versus concurrent chemoradiotherapy alone in locally advanced head and neck cancer（PARADIGM）：a randomised phase 3 trial. Lancet Oncology 14：257-264, 2013

34）Hitt R, et al：A randomized phase Ⅲ trial comparing induction chemotherapy followed by chemoradiotherapy versus chemoradiotherapy alone as treatment of unresectable head and neck cancer. Annals Oncology 25：216-225, 2014

35）Ang KK, et al：A randomized phase Ⅲ trial（RTOG 0522）of concurrent accelerated radiation plus cisplatin with or without cetuximab for stage Ⅲ-Ⅳ head and neck squamous cell carcinoma（HNC）. J Clin Oncol 29：abstr 5500, 2011