铂类药物在头颈部鳞癌治疗中的选择与应用

The selection and application of platinum drugs in the treatment of head and neck squamous cell carcinomas

以铂类药物为基础的化疗成为晚期头颈部鳞癌(head and neck squamous cell carcinoma,HNSCC)综合治疗中不可缺少的部分。化疗可与放疗同步用于局部晚期HNSCC的根治性治疗,或用于具有高危因素的HNSCC术后辅助治疗,也可用于诱导化疗(新辅助化疗)或者放疗后的辅助化疗。同期放化疗在局部晚期HNSCC的治疗中尤其重要。几种常用的铂类药物在HNSCC的治疗中各有优势。本文简述铂类药物的药理作用及机制,比较铂类药物在HNSCC的疗效与毒性,并分析不同给药方式(单药或多药联合,每周或每3周)与给药剂量所带来的疗效与毒性差异,希望能对医师合理使用铂类药物治疗HNSCC有所裨益。

Platinum-based chemotherapy has become an indispensable part in the comprehensive treatment of locally advanced head and neck squamous cell carcinomas(HNSCC). Chemotherapy can be used concurrently with radiotherapy(CCRT) for curative treatment of locally advanced HNSCC. CCRT is also widely applied after surgery for patients with high risk factors. In addition, chemotherapy is used before surgery or radiation(also known as neoadjuvant chemotherapy), or after radiotherapy(adjuvant chemotherapy). CCRT is particularly important for locally advanced HNSCC. Several commonly used platinum drugs all have their own advantages and disadvantages in the treatment of HNSCC. This review includes the anticancer mechanisms and the efficacy and toxicities of the platinum drugs. In addition, several different dosing schedules are listed(high doses given every 3 weeks, moderate doses given weekly, single-agent platinum versus multi-agent platinum-containing regimens), the short and long term survival data and toxicities are also provided, with the hope to give useful information for clinicians.