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Compliance and Efficacy of Induction Chemotherapy with Cisplatin, Docetaxel, and Fluorouracil Followed by Radiotherapy Plus Cisplatin or Cetuximab for Locally Advanced Oropharyngeal Tumours.

Journal of clinical oncology(2013)

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摘要
e17012 Background: This study aimed to assess compliance and survival after induction chemotherapy (IC) with docetaxel, cisplatin, fluorouracil (DCF) followed by radiotherapy plus cisplatin (RTCis) or radiotherapy plus cetuximab (RTCet) in a retrospective multicentric series of 121 patients with locally advanced oropharyngeal cancer. One of the issues of these chemotherapy regimens is the toxicity that adversely affects the compliance to the concomitant radiochemotherapy treatment. We also evaluated feasibility and completion of radiochemotherapy treatment comparing efficacy and toxicity between RTCet and RTCis. Methods: Multicentric retrospective review of 121 consecutive patients with non resectable or non operable oropharyngeal carcinomas treated between 2005 and 2011 in 3 tertiary care centers with protocol ongoing in each center. In one center DCF, is followed by RTCet, in the 2 other centers, DCF is followed by RTCis. Primary endpoints were acute toxicity of IC and compliance to the RTCis compared with RTCet. Secondary endpoints were overall survival, disease free survival and locoregional control. Results: Within the 121 patients, 20.7% were stage III and 79.3% were stage IV. 81.8% of the patients completed the full course of IC. 50% of the patients had full dose concomitant cisplatin versus 77% of the patients that had full dose concomitant cetuximab (p=0.017). Mean follow up was 23.5 months. Median overal survival was 20.7 months, median disease free survival was 18.6 months. The 3 and 5 year overall survival rates were respectively 52.5% and 46.4%. The 3 and 5 year disease free survival rates were 44.2% and 38.3%. The only significant factor affecting survival was IC response (p<0.05). No statistically significant difference in survival was found between patients with concomitant cisplatin or cetuximab. Conclusions: Induction chemotherapy with DCF followed by RTCis or RTCet allowed good survival rates with acceptable toxicities. Cetuximab seemed to be better tolerated than cisplatin improving compliance to the treatment.
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