Therapeutics of Clinical Drugs 臨床藥物治療學 探討目前下咽癌之治療 國軍桃園總院藥劑科藥師王茂富 黃建衡 中華大學科技管理學系教授陳棟樑 摘要 5 hypopharyngeal cancers HNCs CCRT 壹 前言 貳 下咽癌之分期 (hypopharynx) (pyriform sinus) (posterior pharyngeal wall) (post cricoid area) 1 藥學雜誌第 110 冊 109
臨床藥物治療學 Therapeutics of Clinical Drugs 圖一下咽癌好發之部位 (AJCC) (UICC) Tumor Node Metastases (TNM) ( ) 表一 Tumor Node Metastases (TNM) 分類系統 臨床分期 T N M Stage 0 Tis N0 M0 Stage I T1 N0 M0 Stage II T2 N0 M0 T3 N0 M0 T1 N1 M0 Stage III T2 N1 M0 T3 N1 M0 T4a N0 M0 T4a N1 M0 Stage IVa Stage IVb T1 N2 M0 T2 N2 M0 T3 N2 M0 T4a N2 M0 T4b Any N M0 Any T N3 M0 Stage IVc Any T Any N M1 TX T0 Tis T1 T2 T3 Primary tumor (T) 腫瘤大小 <2 2-4 4 T4a T4b NX N0 N1 Regional lymph nodes (N) 局部轉移淋巴結之大小 3 N2a 3-6 6 N2b 6 N2c 6 N3 M0 M1 6 Distant metastasis (M) 遠端轉移 參 下咽癌的治療方式 110 THE JOURNAL OF TAIWAN PHARMACY Vol.28 No.1
(partial laryngopharyngectomy) 2 3 (CRT) 2 Gy 33-35 ( 66-70Gy) 2 ( 6 ) 1.2 Gy/64-66 ( 80 Gy) platinum-based cisplatin carboplatin5-fu paclitaxel platinum-based cetuximab epidermal growth factor receptor (EGFR) cetuximab EGFR EGFR (concurrent chemoradiation therapy) CRT 4,5 CRT CRT 表二常見 CRT 配方 化學治療 Cisplatin (20 mg/m 2 /day) + 5-FU (1000 mg/m 2 /day) 96 Cisplatin (75 mg/m 2 day1)+5- fluorouracil (1000 mg/m 2 /day 96 ) C i s p l a t i n ( 1 2 m g / m 2 / d a y ) + 5 - fluorouracil (600 mg/m 2 /day) 120 Carboplatin 25 mg/m 2 /day infusion C a r b o p l a t i n ( [ A U C ] : 1. 5-2 / ) infusion Carboplatin (70 mg/m 2 /day) + fluorouracil (600 mg/m 2 /day) 96 Paclitaxel (30 mg/m 2 ) + cisplatin (20 mg/m 2 ) 放射線治療 66Gy 藥學雜誌第 110 冊 111
臨床藥物治療學 Therapeutics of Clinical Drugs 化學治療 P a c l i t a x e l ( 4 5 m g / m 2 ) + carboplatin (AUC of 1.5) 放射線治療 72Gy Carboplatin cisplatin platinumbased paclitaxel 一 引導式化學治療 taxanes cisplatin fluorouracil 表三引導化療參考配方 Cisplatin Fluorouracil Taxanes 100 mg/m 2 24 5 cisplatin 75 mg/ m 2 cisplatin 100 mg/ m 2 二 系列性療法 1000 mg/m 2 24 5 5-fluorouracil 750 mg/m 2 5- fluorouracil 500 mg/m 2 docetaxel 75 mg/m 2 paclitaxel 175 mg/m 2 (sequential therapy) 肆 結論 allopurinol GM-CSF 6 / 4-6 7 112 THE JOURNAL OF TAIWAN PHARMACY Vol.28 No.1
參考資料 : 1. http://www.kuleuven.be/cltr/en/hypopharynx/about.htm 2. Chen, S. W., M. H. Tsai, et al: (2008). "Hypopharyngeal cancer treatment based on definitive radiotherapy: who is suitable for laryngeal preservation?" J Laryngol Otol 122(5): 506-12. 3. Holsinger, F. C., H. Y. Lin, et al: (2009). "Platin-based exclusive chemotherapy for selected patients with squamous cell carcinoma of the larynx and pharynx." Cancer 115(17): 3909-18. 4. Forastiere, A. A., H. Goepfert, et al: (2003). "Concurrent chemotherapy and radiotherapy for organ preservation in advanced laryngeal cancer." N Engl J Med 349(22): 2091-8. 5. Soo, K. C., E. H. Tan, et al: (2005). "Surgery and adjuvant radiotherapy vs concurrent chemoradiotherapy in stage III/IV nonmetastatic squamous cell head and neck cancer: a randomised comparison." Br J Cancer 93(3): 279-86. 6. Clarkson, J. E., H. V. Worthington, et al: "Interventions for treating oral mucositis for patients with cancer receiving treatment." Cochrane Database Syst Rev(8): CD001973. 7. Peterson, D. E., R. J. Bensadoun, et al: "Management of oral and gastrointestinal mucositis: ESMO Clinical Practice Guidelines." Ann Oncol 21 Suppl 5: v261-5. Current Therapy of Hypopharyngeal Cancer Mau-Fu Wang 1, Chien-Heng Huang 1, Tung-Liang Chen 2 Department of Pharmacy, Taoyuan Armed Forces General Hospital 1 Department of Technology Management, Chung Hua University 2 Abstract Hypopharyngeal cancers has the worst prognosis and distant metastasis at presentation is more common than in other head and neck cancers. The main risks are smoking and alcohol use. Unfortunately, 5-year survival rate remains poor despite recent improvements in diagnostic imaging, radiation and chemotherapy, and improved surgical techniques. Presenting symptoms include dysphagia, sore throat, odynophagia, hoarseness, otalgia, dyspnea/stridor, and neck mass. Historically, radiotherapy and surgery are usually used to treat Hypopharyngeal cancers. Recently, the main goals of therapy are ablation of the cancer while minimizing morbidity preserving function and cosmesis. Organ preservation in hypopharyngeal carcinoma also been a major target for clinical research in the last years. Concurrent chemoradiation therapy (CCRT) seems a better option to us since it gives a better chance of organ preservation. 藥學雜誌第 110 冊 113