手术不可切除的复发颞骨鳞癌的综合治疗探讨

Combined Modality Treatment for recurrent unresectable squamous cell carcinoma of temporal bone

目的探讨同步放化疗、化疗和EGFR分子靶向药物综合治疗对手术不可切除的复发颞骨鳞癌的治疗有效性。方法回顾性分析2008年1月至2012年6月期间6例手术不可切除的颞骨鳞癌(男4例,女2例,年龄34～63岁,平均51.17岁),5例侵犯至颅脑和海绵窦区颈内动脉,1例侵犯颅底破裂孔区颈内动脉。根据患者以往采取的治疗方式制定个体化的治疗方案,分别采用了同步放化疗和(或)EGFR分子靶向治疗及TPF化疗方案(多西他塞docetaxel,顺铂cisplatin,氟尿嘧啶5-fluorouracil)化疗。结果 1例完全缓解(Complete Response,CR),5例部分缓解(Partial Response,PR),有效率100%。随访3～30个月,1例健在,5例死亡。结论同步放化疗、化疗及分子靶向药物治疗对手术不可切除的原发或复发颞骨恶性肿瘤的治疗有效。有效的治疗可能使手术无法切除的颞骨鳞癌的治疗模式从姑息治疗转变为根治性治疗,给予了晚期患者治愈的机会。

Objective To study the efficiency of combined modality treatment with Helical tomotherapy （HT）,chemo- therapy and EGFR molecular targeted therapy in recurrent unreseetable squamous cell carcinoma （SCC） of temporal bone. Methods Six patients （5 males and 1 female, 34 to 63 years old, mean age = 51.17 years） with unresectable carcinoma of the temporal bone treated between January 2008 and June 2012 were studied. The SCCs invaded the carotid artery of cav- ernous sinus in 5 patients,and the carotid artery of skull base foramen in 1 patient. The patients received chemotherapy with TPF regimen（doeetaxel,eisplatin and 5-fluorouracil）and/or EGFR molecular targeted therapy, or concurrent chemoradio- therapy （CCTT） followed by chemotherapy, or induction chemotherapy followed by CCTT. Results Complete response （CR） was achieved in 1 patient, and partial response （PR） in 5 patients, with a total response rate of 100%. Conclusion The com- bined modality treatment is effective on unreseetable tumor of the temporal bone. The treatment may be the best option for patients with unresectable diseases, potentially changing the therapeutic strategy from palliative to curative.