西妥昔单抗联合调强放疗及TP方案化疗治疗局部晚期鼻咽癌初步研究

Preliminary Results of Cetuximab Combined with Intensitymodulated Radiotherapy(IMRT) and TP Regimen Chemotherapy for Locally Advanced Nasopharyngeal Carcinoma

[目的]研究西妥昔单抗联合调强放疗及TP方案化疗治疗局部晚期鼻咽癌的近期疗效及不良反应。[方法]21例局部区域晚期鼻咽癌患者接受调强放射治疗及TP方案同步化疗2个周期,同时接受每周1次的西妥昔单抗治疗。采用CTCAE3.0记录治疗期间的最大不良反应;观察局部区域控制及远处转移情况。[结果]21例患者都完成预定调强放射治疗计划,20例(95.2%)患者完成了预定的西妥昔单抗治疗,19例(90.5%)患者完成了2个周期的TP方案化疗。无治疗相关性死亡发生,4级不良反应包括白细胞减少(7例,33.4%),中性粒细胞减少(3例,14.3%),血小板减少(1例,4.8%)及4级唑疮样皮疹(1例,4.8%)。口腔及口咽黏膜炎、骨髓抑制、放射性皮炎、呕吐为常见的3级毒性。中位随访13个月,21例患者1年局部控制率、区域控制率及无远处转移生存率为100.0%、100.0%及95.2%。[结论]西妥昔单抗联合调强放疗及TP方案化疗治疗局部晚期鼻咽癌近期疗效令人鼓舞,不良反应可控可逆。

[Purpose] To investigate the short term response and toxicity of cetuximab combined with intensity-modulated radiotherapy （IMRT） and TP regimen chemotherapy for locally ad- vanced nasopharyngeal carcinoma （NPC）. [Methods] Twenty-one cases with locally advanced NPC were treated with IMRT,two cycles of concurrent TP regimen chemotherapy, and cetuximab weekly. The severest acute toxicities were recorded according to Common Terminology Criteria for Adverse Events （CTCAE） version 3.0, and the local control and distance metastasis were ob- served. [Results] All the 21 patients finished planned radiation dose,20 patients （95.2%） fin- ished planned cetuximab therapy, 19 patients （90.5%） finished planned two cycles of TP regi- men chemotherapy. No treatment related death happened. Grade 4 toxicities included leukope- nia（7 cases, 33.4%）,neutropenia （3 cases, 14.3%）,thrombocytopenia （1 case,4.8%）,acneiform rash grade 4 （1 case ,4.8%）. Oral and oropharyngeal mncositis, marrow depression, radiotherapy induced dermatitis,and vomitting were common toxicity with grade 3. With a median follow-up of 13 months,the local,regional,and distant control rate for the 21 cases were 100.0%, 100.0% and 95.2% respectively. [Conclusion] Cetuximab in combination with IMRT and TP regimen chemotherapy is a feasible strategy against locally advanced NPC with controllable and re- versible toxicities.