西妥昔单抗联合放化疗治疗晚期头颈部恶性肿瘤

目的 观察西妥昔单抗联合放化疗治疗晚期头颈部恶性肿瘤（HNSCC）的有效性和安全性.方法 2007年11月至2010年5月经病理证实的26例晚期HNSCC患者,接受西妥昔单抗联合放化疗治疗.西妥昔单抗静脉滴注给药,首剂400mg/m2,后续剂量250mg/m2,每周1次,连用5~12周.其中23例患者同时接受放疗,原发灶剂量为60~74.25Gy,转移淋巴结为60~72Gy.18例患者同时接受化疗,方案为PF或TPF.结果 评估患者近期疗效和急性不良反应.所有患者在治疗后3个月时进行疗效评价：完全缓解（CR）65.4%（17/26）,部分缓解（PR）15.38%（4/26）,稳定（SD）11.5%（3/26）,进展（PD）3.8%（1/26）,术后无法评价疗效1例.其中19例初治的HNSCC患者中,CR73.7%（14/19）,PR15.7%（3/19）,SD5.3%（1/19）,PD5.3%（1/19）;7例复发或转移的患者中,CR42.8%（3/7）,SD28.6%（2/7）,PD28.6%（2/7）.治疗中出现的主要不良反应包括口咽黏膜炎、舌黏膜炎和特异性痤疮样皮疹.26例患者均完成随访,中位随访时间11个月,随访中5例PD,疾病进展时间（TTP）为4~22个月,中位数为7个月,生存时间4~33个月,中位数为11个月.10例初治鼻咽癌患者无一出现转移或复发.结论 西妥昔单抗联合放化疗治疗晚期HNSCC,近期疗效满意,痤疮样皮疹为药物特异性副作用,未出现影响治疗进行的严重特异性不良反应.

Cetuximab combined with chemotherapy or radiotherapy in treatment of advanced or recurrent head and neck cancer

Objective To evaluate the safety, tolerability and efficacy of cetuximab combined with chemotherapy or radiotherapy in treatment of advanced or recurrent head and neck cancer. Methods Twenty six patients with advanced or recurrent head and neck cancer were treated with cetuximab in combination with radiotherapy and/or chemotherapy from Nov 2007 to May 2010. The efficacy and adverse events of therapy were assessed. Results Out of 26 cases, 17 achieved CR, 4 achieved PR, 3 achieved SD, 1 had PD and 1 patient could not be evaluated. The loading dose of cetuximab was 400mg/m2, followed by weekly infusions of 250mg/m2, All patients were followed up for a median of 11 months. During the follow-up 5 patients were found to have PD, the time of tumor progression （TTP） was 4 to 22 months with a median of 7 months; the survival time was 4 to 33 months with a median of 11 months. The most common adverse events were skin reactions, especially acne-like rash. The radiation mucositis during the combined treatment was the mainly RT/CT side effects and well-tolerated. Conclusion Cetuximab can enhance the short-term efficacy of chemo/radiotherapy without increasing toxicities associated with chemo/radiotherapy, except coexisting acne-like rash.