Amifostine and Concurrent Chemoradiation Therapy for Head and Neck Cancers-Mackay Memorial Hospital

Amifostine併同步化學放射線治療在頭頸部癌症患者的運用－馬偕醫院經驗

謝忱希(Chen-His Hsieh) ； 張國華(Kou-Hwa Chang) ； 陳裕仁(Yu-Jen Chen) ； 蘇文浩(We-Hao Su) ； 洪世凱(Shih-Kai Hung) ； 賴允亮(Yuen-Liang Lai)

《醫護科技學刊》 7卷2期 (2005/04) Pp. 121-128

https://doi.org/10.6563/TJHS.2005.7(2).1

摘要

對正常組織的毒性反應作用一直是放療或是同步性化學放射線治療(CCRT)的主要限制因素。因Amifostine能夠避免放療及化療的毒性反應。故在這次的研究裡，我們嘗試去評估amifostine使用在頭頸部癌的患者接受同步性化學放射線治療時的保護效果與其毒性；並將此經驗報告之。
自2002年11月至2003年6月，共6位接受同步性化學放射線治療，每次放射線治療前15分鐘，皆給予amifostine(300.0 mg/平方公尺)3分鐘的快速滴注。患者接受的放射線治療劑量為每日1.8Gy，平均為65.4Gy（範圍從55.8至72.0Gy）。化學治療劑量為在放射線治療期間，每週接受cisplatin (CDDP) 30.0mg/平方公尺，每3週休息l週。
Amifostine所造成的副作用與併用同步性化學放射線治療的副作用的評估乃是依據CTC。大多數患者對amifostine耐受性良好，而噁心、嘔吐是amifostine 最常見的副作用。6位病人在接受amifsotine後皆產生噁心、嘔吐；其中有3位至少有一次2級的噁心、嘔吐經驗；有2位至少有一次3級的噁心、嘔吐。有1位發生嚴重（4級）的噁心、嘔吐。在同步性化學放射線治療併Amifostine治療後，副作用皆不嚴重；有4位發生2級的吞嚥困難、口腔黏膜炎及皮膚炎。有3位發生2級的口乾。值得注意的是，其中一位鼻咽癌復發的患者在同步性化學放射線治療中產生嚴重的副作用。
Amifostine可降低頭頸部癌接受同步性化學放射線治療患者的副作用。此外，對復發性的頭頸部患者amifostine是否適用仍須進一步考量。

關鍵字

Amifostine ； 同步性化學放射線治療 ； 口乾

並列摘要

Normal tissue toxicity is a major treatment-limiting factor in concurrent chemoradiation therapy (CCRT). Amifostine has shown to limit cytotoxic damage induced by CCRT. In this report, the protective effects of amifostine were evaluated and the adverse effects related to its use were documented in patients with head and neck (HNC) receiving CCRT.
From November 2002 to June 2003, six patients with HNC were treated with CCRT and a rapid three-minute intravenous infusion of amifostine (300.0 mg/m^2) was administered 15 minutes before each fraction of radiotherapy (RT). Patients received a mean total RT dosage of 65.4 Gy (range: 55.8 to 72.0 Gy) by a daily fraction of 1.8 Gy. Chemotherapy comprised two courses of three consecutive weekly cisplatin (CDDP) infusions at a dosage of 30.0 mg/body surface area. Patients received one week of rest after the first 3 doses were administered.
Assessments of amifostine- and CCRT-related toxicity were graded according to the Common Toxicity Criteria published by National Cancer Institute. Amifostine was well-tolerated in most cases. The most common adverse effect related to amifostine used was nausea/vomiting, which occurred in all patients with three of grade Ⅱ(3/6) and two of grade Ⅲ(2/6). Although CCRT related toxicities developed in all cases, most of these toxicities were noted as grade Ⅱ, grade Ⅱ dysphagia. mucositis, and dermatitis developed in four patients, and grade Ⅱ xerostomia occurred in three. Notably, one case with recurrent nasopharyngeal cancer had to prematurely terminate the treatment course due to high grades (Ⅲ and Ⅳ) of amifostine-and CCRT-related toxicities developed.
The preliminary findings of this report showed that aminofostine pretreatment was well tolerated when administered and appeared to be effective in reducing CCRT induced toxicities in patients with HNC. However, further investigations are needed to determine if amifostine administration is suitable for patients with recurrent cancers.

並列關鍵字

Amifostine ； concurrent chemoradiation therapy (CCRT) ； xerostomia

參考文獻

Anne, P. R.,Curran, W. J. Jr.(2002).A phase II trial of subcutaneous amifostine and radiation therapy in patients with head and neck cancer.Semin Radiat Oncol.12,18-19.

Antonadou, D.,Pepelassi, M.,Synodinou, M.,Puglisi, M.,Throuvalas, N.(2002).Prophylactic use of amifostine to prevent radiochemotherapy-induced mucositis and xerostomia in head-andneck cancer.Int J Radiat Oncol Biol Phys.52(3),739-747.

April G. Fritz.,Frederick L. Greene.,Hutter RVP(2002).(Manual for Staging of Cancer).

Bourhis, J.,De Crevoisier, R.,Abdulkarim, B.,Deutsch, E.,Lusinchi, A.,Luboinski, B.(2000).A randomized study of very accelerated radiotherapy with and without amifostine in head and neck squamous cell carcinoma.Int J Radiat Oncol Biol Phys.46,1105-1108.

Bourhis, J.,Rosine, D.(2002).Radioprotective effect of amifostine in patients with head and neck squamous cell carcinoma.Semin Oncol.29,61-62.