摘要
背景与目的:最新研究报道,西妥昔单克隆抗体(单抗)联合放疗较单纯放疗降低了局部晚期头颈部鳞癌患者的死亡率。为探讨西妥昔单抗在鼻咽癌中的作用,本研究初步观察西妥昔单抗联合放化疗治疗晚期鼻咽癌患者的不良反应及近期疗效。方法:取我院收治的晚期鼻咽癌患者12例。西妥昔单抗与放疗或化疗或同步放化疗同时使用,用法:西妥昔单抗第1周初始剂量为400mg/m2,以后每周维持剂量为250mg/m2,共8周。初诊或局部复发鼻咽癌患者均采用调强放疗技术,给予鼻咽部GTV处方剂量DT6975cGy/31次,6.2周完成。对鼻咽癌转移灶姑息放疗,予转移灶外照射DT3000cGy/10次,2周完成。结果:2例放疗后多脏器转移患者因病情进展而停用西妥昔单抗,2例初诊鼻咽癌因西妥昔单抗引起的Ⅲ级舌黏膜反应而停药,2例因Ⅲ级皮疹延迟用药1周,余6例顺利完成治疗计划。西妥昔单抗主要不良反应为皮疹、甲沟炎、黏膜反应、疲乏等。10例鼻咽部调强放疗同时使用西妥昔单抗的患者中,5例出现Ⅲ级口咽黏膜反应,其中4例同时出现Ⅲ级舌黏膜反应。全组完全缓解7例(58.3%),部分缓解3例(25.0%),疾病稳定2例(16.7%)。中位随访14个月,2例死亡,10例存活且肿瘤无进展。结论:西妥昔单抗联合放化疗治疗晚期鼻咽癌的安全有效,但联合鼻咽部调强放疗时少部分患者出现较重的舌黏膜反应,影响治疗计划的顺利进行,需进行进一步临床试验研究。
Background and purpose： Recently study, cetuximab combined with radiotherapy reduced the rate of death for local advanced head and neck cancer when compared with radiotherapy alone. To realize it＇s utilization in nasopharyngeal carcinoma （NPC）, in this study we explored the side effects and efficiencies of cetuximab when it was used combined with radiotherapy and chemotherapy for advanced NPC. Methods： 12 patients with NPC were treated with cetuximab which was used concurrently with radiotherapy and chemotherapy. Cetuximab was given to an initial dose of 400 mg/m^2 in the first week followed by weekly injection of 250 mg/m^2.Untreated or locally recurrent NPC received intensity-modulated radiotherapy （IMRT）, a dose of 6 975 cGy by 31 times in 6.2 weeks were given to the GTV in nasopharynx. Conventional technology was used for the metastatic tumor of NPC, a dose of 3 000 cGy by 10 times in 2 weeks were given. Results： Two patients with metastatic NPC after radical radiotherapy discontinued cetuximab because of disease progression. Two new NPC cases discontinued cetuximab because of grades Ⅲ mucositis of tongue. Two patients were delayed for one week of giving cetuximab because of grade Ⅲ rash. The rest 6 patients completed the planned treatment. The main side effects were acne-like or maculopapular rash, paronychia, stomatitis, and asthenia et al. 10 patients received cetuximab concurrently with IMRT of nasopharynx, 5 patients had grade Ⅲ mucositis of oropharynx and in which 4 patients had specific grade Ⅲ mucositis of tongue.At a median follow-up of 14 months, two patients with metastatic NPC after radical radiotherapy were died, 10 patients including 4 metastatic NPC obtained disease-free survival. Conclusion： cetuximab combined with radiotherapy and chemotherapy was efficient and safe for advanced nasopharyngeal carcinoma. When cetuximab was used concurrently with IMRT in cancer of the nasopharynx, we observed specific grade Ⅲ mucositis of tongue which caused the planned treatment to be discontinued , Further clinical study is needed.
出处
《中国癌症杂志》
CAS
CSCD
北大核心
2009年第2期133-137,共5页
China Oncology
关键词
西妥昔单抗
鼻咽癌
放射治疗
化疗
cetuximab
nasopharyngeal carcinoma
radiation therapy
chemotherapy
