螺旋断层放疗联合抗表皮生长因子受体单抗治疗鼻咽癌的临床研究

目的探讨螺旋断层放疗联合抗表皮生长因子受体(anti-epidermal growth factor receptor,EGFR)单克隆抗体治疗鼻咽癌的近期疗效和不良反应。方法回顾性分析2008年3月-2009年11月我科收治的34例行根治性螺旋断层放疗的鼻咽癌患者临床资料。处方剂量:鼻咽部肿瘤(pGTVnx)及可见的转移淋巴结(pGTVnd)70Gy/33次,高危临床靶区(PTV1)60Gy/33次,预防照射区(PTV2)56Gy/33次,5次/周。其中17例放疗期间联合尼妥珠单抗,200mg/次,静滴,每周1次,共6-7次(尼妥珠组);另17例放疗期间联合西妥昔单抗,首次剂量400mg/m2,以后每周250mg/m2,静滴,每周1次,共6-7次(西妥昔组)。参照RECIST 1.0版实体瘤评价标准评价疗效,采用RTOG/EROTC标准评价急性反应。结果随访27-48个月,中位随访时间36个月。放疗后1、2、3年区域局部复发率、淋巴结复发率、远处转移生存率、总生存率,尼妥珠组均为0、0、17.6%和88.2%,西妥昔组均为0、0、11.8%和100%,两组差异无统计学意义。放疗后急性反应,尼妥珠组口腔黏膜反应(u=2.25,P<0.05)、体重下降程度(t=2.56,P=0.02)、皮疹(u=4.36,P<0.01)较西妥昔组轻。结论螺旋断层放疗联合尼妥珠单抗与联合西妥昔单抗治疗鼻咽癌的1、2、3年临床疗效无差异,急性反应尼妥珠单抗较西妥单抗轻,但均可耐受。

Treatment of nasopharyngeal carcinoma with combined helical tomotherapy and anti-EGFR monoclonal antibody

Objective To study the short-term outcome and adverse reactions of combined helical tomotherapy and anti-EGFR monoclonal antibody in patients with nasopharyngeal carcinoma（NPC）.Methods Clinical data about 34 NPC patients who underwent helical tomotherapy in our hospital from March 2008 to November 2009 were retrospectively analyzed.Gross tumor volume（pGTVnx） with visible lymphnodes（GTVnd） underwent helical tomotherapy at the dose of 70Gy for 33 fractions,high risk clinical target volume（PTV1） received helical tomotherapy at the dose of 60Gy for 33 fractions,and low risk clinical target volume（PTV2） accepted helical tomotherapy at the dose of 56Gy for 33 fractions.Of the 34 patients,17 underwent combined helical tomotherapy and nimotuzumab（200mg）,once a week for 6-7 weeks,and 17 received combined helical tomotherapy and cetuximab（400mg/m2） followed by 250mg/m2,once a week for 6-7 weeks.Their clinical outcomes were assessed according to RECIST 1.0 and acute reactions were assessed following the RTOG/EORTC criteria.Results The patients were followed up for 27-48 months（mean 36 months）.The 1-,2and 3-year survival rates of patients with local and lymph node relapse,and the overall survival（OS） rate of patients with distant metastasis were 0,0,17.6% and 88.2% in combined helical tomotherapy and nimotuzumab group and 0,0,11.8% and 100% in combined helical tomotherapy and cetuximab group（P0.05）.The incidence of mucosal reaction（u=2.25,P0.05）,weight loss（t=2.56,P=0.02） and rash（u=4.36,P0.01） was higher in combined helical tomotherapy and nimotuzumab group than in combined helical tomotherapy and cetuximab group.Conclusion No significant difference can be found in 1-,2-and 3-year survival rates in NPC patients after combined helical tomotherapy and nimotuzumab or cetuximab.The acute reaction to nimotuzumab is milder than that to cetuximab and tolerable in NPC patients.