Comparison of the efficacy and safety of concurrent chemoradiotherapy with platinum-based or taxanes-based for LAHNSCC after induction chemotherapy

No randomized trials confirm the efficacy of concurrent chemoradiotherapy (CCRT) in platinum-ineligible patients with locally advanced head and neck squamous cell carcinoma (LAHNSCC) post-induction chemotherapy (IC). This study evaluates the efficacy of platinum-based versus taxane-based CCRT after IC in LAHNSCC patients, excluding nasopharyngeal carcinoma, to assess the viability of taxanes as a platinum alternative. A retrospective analysis was conducted on 215 LAHNSCC patients treated with IC using nab-paclitaxel/docetaxel, cisplatin, and fluorouracil (AP/APF or TP/TPF). During CCRT, patients were divided into platinum and taxane groups. Survival rates, and safety profiles of nab-paclitaxel versus docetaxel were compared. All patients received Helical tomotherapy and Intensity-modulated radiotherapy at 60–70 Gy. No significant differences were observed in CR rates, 3-year progression-free survival (PFS) (75.2 vs. 84.8%), or overall survival (OS) (72.1 vs. 84.1%) between taxane and platinum groups. Within the taxane group, CR rates and 3-year PFS showed no significant difference. However, the nab-paclitaxel group demonstrated significantly improved 3-year OS (80.9 vs. 67.6%) and disease-specific survival (DSS) (94.09 vs. 70.72%) compared to the docetaxel group. Taxane-based CCRT after IC is as effective as platinum-based treatment with manageable toxicity. Nab-paclitaxel surpassed docetaxel in 3-year OS and DSS.

目前尚无随机试验证实，针对诱导化疗（induction chemotherapy, IC）后不适合铂类治疗的局部晚期头颈部鳞状细胞癌（locally advanced head and neck squamous cell carcinoma, LAHNSCC）患者，同步放化疗（concurrent chemoradiotherapy, CCRT）的疗效。本研究针对排除鼻咽癌的LAHNSCC患者，评估诱导化疗后铂类为基础与紫杉类为基础的同步放化疗疗效，以明确紫杉类作为铂类替代方案的可行性。本研究对215例接受以白蛋白结合型紫杉醇/多西他赛、顺铂及氟尿嘧啶（AP/APF或TP/TPF方案）诱导化疗的LAHNSCC患者开展回顾性分析。同步放化疗期间，将患者分为铂类组与紫杉类组，对比白蛋白结合型紫杉醇与多西他赛的生存结局及安全性特征。所有患者均接受60~70 Gy剂量的螺旋断层放疗（Helical tomotherapy）与调强放射治疗（Intensity-modulated radiotherapy）。紫杉类组与铂类组的完全缓解率、3年无进展生存期（progression-free survival, PFS）（75.2% vs. 84.8%）及总生存期（overall survival, OS）（72.1% vs. 84.1%）均无显著差异。在紫杉类组内部，完全缓解率与3年PFS亦无显著差异。但相较于多西他赛组，白蛋白结合型紫杉醇组的3年总生存期（80.9% vs. 67.6%）与疾病特异性生存期（disease-specific survival, DSS）（94.09% vs. 70.72%）均显著更优。诱导化疗后采用紫杉类为基础的同步放化疗，疗效与铂类为基础的治疗相当，且毒性反应可控。白蛋白结合型紫杉醇在3年OS与DSS方面优于多西他赛。