頭頸部癌に対する導入化学療法の再考―縮小手術の可能性―

抄録

The role of induction chemotherapy (ICT) for advanced head and neck cancer is still controversial, because of the lack of definitive evidence. Several previous meta-analyses have indicated the contribution of concurrent chemoradiotherapy (CRT) to improvement of the survival, but found no evidence to recommend induction chemotherapy. However, the TPF regimen, consisting of cisplatin+fluorouracil+docetaxel, has been identified as a new effective ICT regimen, and the possible contribution of TPF-ICT to improving the curability of advanced head and neck cancer has been reported. There are also reports supporting the notion that ICT can reduce the incidence of distant metastasis. This is for head and neck cancer only. The recent concept of chemoselection has also attracted attention to ICT, in which the choice of radical surgery or CRT is made on the basis of the tumor response to ICT. We have also demonstrated the possibility of limited surgery after ICT to preserve tissues to the maximum extent possible, which would, in turn, lead to preservation of function. Among the head and neck cancers, oral cancer is the best candidate for limited surgery, and sinus cancer is better treated by limited surgery. It is not easy to determine the indications of limited surgery for advanced laryngeal cancer, but some cases may be appropriate candidates for limited surgery. Continuing research is important to clarify the roles of ICT for locally advanced head and neck cancer.