局部晚期头颈部鳞癌放疗联合EGFR单抗的疗效分析

目的 分析放疗联合表皮生长因子受体(EGFR)单抗治疗局部晚期头颈部鳞癌(LA-SCCHN)疗效。方法 2009—2011年间 77例SCCHN接受了调强放疗为主联合西妥昔单抗或尼妥珠单抗的患者入研究组,依性别、年龄、病种、分期、放疗技术与研究组一致原则选取同时期放疗未联合EGFR抑制剂的 72例LA-SCCHN患者作为对照组。比较两组局部控制率、生存率及急性不良反应并分析预后影响因素。Kaplan-Meier计算局部控制率、生存率并Logrank法检验,Cox模型多因素预后分析。结果 研究组、对照组中位随访时间分别为18.0、19.5个月,随访率100%。2年局部控制率、总生存率、无瘤生存率分别为78%和60%(χ²=4.88,P=0.027)、64%和59%(χ²=0.87,P=0.351)、60%和46%(χ²=2.12,P=0.146)。研究组较对照组患者3+4级放射性黏膜炎高(51%∶17%,χ²=19.09,P=0.000)、白细胞下降发生率也高(8%∶0%,χ²=4.00,P=0.045)。多因素预后分析显示原发部位、T分期、N分期、是否同期化疗、是否联合EGFR单抗是局部控制的影响因素。结论 与放疗未联合EGFR抑制剂相比调强放疗联合EGFR单抗治疗LA-SCCHN提高了局部控制率,但未提高总生存率和无瘤生存率,且不良反应可耐受。

Therapeutic efficacy of radiotherapy combined with anti-epidermal growth factor receptor monoclonal antibody in treatment of locally advanced squamous cell carcinoma of the head and neck

Objective To analyze the therapeutic efficacy of radiotherapy combined with anti-epidermal growth factor receptor (EGFR) monoclonal antibody in the treatment of locally advanced squamous cell carcinoma of the head and neck (LA-SCCHN). Methods From January 2009 to December 2011, 77 SCCHN patients, who received intensity-modulated radiotherapy (IMRT) combined with cetuximab or nimotuzumab, were included in the study group. Another 72 LA-SCCHN patients, who received radiotherapy alone in the same period, were chosen as a control group. The control group was similar to the study group in sex, age, primary site of tumor, staging, and radiation technique. The two groups were compared in terms of local control (LC), overall survival (OS), disease-free survival (DFS), and acute side effects. The Kaplan-Meier method was used for calculating LC, OS, and DFS rates, and the differences between the two groups were analyzed by Logrank test. Multivariate prognostic analysis was performed using a Cox model. Results The median follow-ups were 18.0 months in the study group and 19.5 months in the control group;the follow-up rate was 100% in both groups. The 2-year LC rate of study group was significantly higher than that of control group (78% vs 60%, χ²=4.88, P=0.027). There were no significant differences in 2-year OS rate (64% vs 59%,χ²=0.870, P=0.351) and DFS rate (60% vs 46%, χ²=2.12, P=0.146) between the two groups. Compared with the control group, the study group had a significantly higher incidence rate of grade 3+4 radiation mucositis (51% vs 17%, χ²=19.09, P=0.000) and a significantly higher incidence rate of leukocyte reduction (8% vs 0%, χ²=4.00, P=0.045). Multivariate prognostic analysis showed that primary site of tumor, T stage, N stage, whether to perform concomitant chemotherapy,and whether to be combined with anti-EGFR monoclonal antibody were the influential factors for LC. Conclusions Compared with IMRT alone, IMRT combined with anti-EGFR monoclonal antibody can increase LC rate in the treatment of LA-SCCHN, but cannot significantly improve OS and DFS rates. Furthermore, it has tolerable side effects.