RESUMO
PURPOSE: The poor functional outcome in patients with advanced head and neck squamous cell carcinoma (HNSCC) with surgery and radiation has led to alternative approaches to advanced disease. We conducted a phase II study of induction chemotherapy followed by concurrent chemoradiotherapy for organ preservation in patients with advanced resectable and unresectable (nasopharyngeal) tumors. PATIENTS AND METHODS: Forty-two patients with stage III to IV resectable HNSCC and nasopharyngeal tumors received induction chemotherapy with two courses of cisplatin (20 mg/m2/d continuous infusion [CI]), fluorouracil (800 mg/m2/d CI), and leucovorin (500 mg/m2/d CI; PFL) for 4 days followed by concurrent therapy with cisplatin (100 mg/m2/d on days 1 and 22) and approximately 70 Gy of external-beam radiotherapy. RESULTS: Response to induction chemotherapy included partial response rate of 52% and complete response rate of 24%. The most common grade 3 or 4 toxicity was neutropenia (59%). After cisplatin chemoradiotherapy the complete response rate was 67%. Toxicities of cisplatin chemoradiotherapy consisted of grade 3 or 4 mucositis (79%) and neutropenia (51%). At a median follow-up of 71.5 months, 43% of the patients are still alive and disease-free. The 5-year progression-free survival (PFS) rate was 60%, and the 2- and 5-year overall survival (OS) rates were 67% and 52%, respectively. Three patients died of second primaries. Late complications of treatment included xerostomia and hoarseness. One patient had persistent dysphagia and required laser epiglotectomy 108 months after treatment. CONCLUSION: Induction chemotherapy with PFL followed by concurrent cisplatin chemoradiotherapy is well tolerated and results in a good likelihood of organ preservation and excellent PFS and OS.
Assuntos
Antineoplásicos/administração & dosagem , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Carcinoma de Células Escamosas/terapia , Cisplatino/administração & dosagem , Cisplatino/uso terapêutico , Fluoruracila/uso terapêutico , Neoplasias de Cabeça e Pescoço/terapia , Leucovorina/uso terapêutico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Braquiterapia , Carcinoma de Células Escamosas/tratamento farmacológico , Carcinoma de Células Escamosas/mortalidade , Carcinoma de Células Escamosas/radioterapia , Cisplatino/efeitos adversos , Terapia Combinada , Esquema de Medicação , Feminino , Fluoruracila/efeitos adversos , Seguimentos , Neoplasias de Cabeça e Pescoço/tratamento farmacológico , Neoplasias de Cabeça e Pescoço/mortalidade , Neoplasias de Cabeça e Pescoço/radioterapia , Humanos , Leucovorina/efeitos adversos , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Indução de Remissão , Taxa de Sobrevida , Resultado do TratamentoRESUMO
Group B streptococcus (GBS) or Streptococcus agalactiae is recognized as a mayor cause of neonatal meningitis, sepsis and infections during pregnancy. However, in recent years there have been several reports concerning GBS infections in non pregnant adult population, specially in immunocompromised hosts and in patients with severe underlying diseases such as diabetes mellitus and cancer. We report a series of 45 cases which occurred in nonpregnant adult population during a period of two years. The average age was 50.8 years and most patients (38/44) had one or more risk factors: diabetes mellitus was the most significant underlying disease. The most frequent infection localization was skin and soft tissues followed by urinary tract infection. Several isolated cases of pneumonia, bacteremia, endocarditis, endometritis and peritonitis were observed. GBS infections should no longer be exclusively considered as perinatal and peripartum events. New clinical presentations are arising in non pregnant adult population with special incidence in immunocompromised hosts. We are obliged to keep this in mind and remember that SGB may be a possible etiologic agent for infections, particularly in skin and soft tissues of diabetic patients.
Assuntos
Infecções Estreptocócicas/microbiologia , Streptococcus agalactiae/isolamento & purificação , Adulto , Idoso , Idoso de 80 Anos ou mais , Argentina/epidemiologia , Comorbidade , Diabetes Mellitus/epidemiologia , Feminino , Humanos , Hospedeiro Imunocomprometido , Masculino , Pessoa de Meia-Idade , Neoplasias/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Infecções Relacionadas à Prótese/epidemiologia , Fatores de Risco , Infecções dos Tecidos Moles/epidemiologia , Infecções dos Tecidos Moles/microbiologia , Infecções Estreptocócicas/epidemiologia , Infecções Urinárias/epidemiologia , Infecções Urinárias/microbiologiaRESUMO
Group B streptococcus (GBS) or Streptococcus agalactiae is recognized as a mayor cause of neonatal meningitis, sepsis and infections during pregnancy. However, in recent years there have been several reports concerning GBS infections in non pregnant adult population, specially in immunocompromised hosts and in patients with severe underlying diseases such as diabetes mellitus and cancer. We report a series of 45 cases which occurred in nonpregnant adult population during a period of two years. The average age was 50.8 years and most patients (38/44) had one or more risk factors: diabetes mellitus was the most significant underlying disease. The most frequent infection localization was skin and soft tissues followed by urinary tract infection. Several isolated cases of pneumonia, bacteremia, endocarditis, endometritis and peritonitis were observed. GBS infections should no longer be exclusively considered as perinatal and peripartum events. New clinical presentations are arising in non pregnant adult population with special incidence in immunocompromised hosts. We are obliged to keep this in mind and remember that SGB may be a possible etiologic agent for infections, particularly in skin and soft tissues of diabetic patients.