西妥昔单抗联合适形调强放疗和化疗治疗鼻咽癌的临床分析

目的：：分析西妥昔单抗联合适形调强放疗和化疗治疗鼻咽癌的临床疗效，毒性反应和预后因素。方法：纳入2006年3月至2011年3月在我院初治，无远处转移的Ⅱ～Ⅳ期鼻咽癌共72例。西妥昔单抗初始剂量为400 mg／m2，之后为每周250 mg／m2。所有患者接受适形调强放疗，接受诱导和／或同步化疗。结果：中位随访60.5月（5～110月）。全组患者3年、5年无局部区域复发生存率（local regional recurrence-free survival，LRRFS）、无远处转移生存率（distant metastasis free-survival ，DMFS）、无进展生存率（progression-free survival，PFS）；总生存率（overall survival，OS）分别为86.1％，75.4％；79.2％，67.9％；77.8％，66.7％和88.9％，76.7％。Ⅱ～Ⅲ期和Ⅳ期患者的5年 PFS 及 OS 分别为83.3％，97.1％和51.7％，58.3％。4例患者出现局部区域复发，共有17例患者出现远处转移。死亡14例患者中8例死于单纯远处转移。单因素分析显示肿瘤分期为 PFS 和 OS 的预后因素（P ＝0.0146，P＝0.0021）。分别有62.5％和4.2％患者发生3和4级口腔粘膜炎。14例患者出现颞叶损伤。结论：西妥昔单抗联合 IMRT 加化疗治疗鼻咽癌的临床疗效较好，毒性反应可耐受。值得扩大样本量以及开展前瞻性随机对照试验进一步研究。

Clinical Outcomes and Prognostic Factors of Cetuximab plus Intensity-modulated Radiotherapy (IMRT)with Chemotherapy for Nasopharyngeal Carcinoma

Objective:To evaluate the clinical outcomes,toxicities and prognostic factors of cetuximab plus intensity-modulated radiotherapy (IMRT)with chemotherapy for nasopharyngeal carcinoma(NPC).Methods:From March 2006 to March 2011,72 patients with stageⅡ~Ⅳ NPC without distant metastasis were included in our study.Cetuximab was administered at an initial dose of 400 mg/m2 followed by weekly doses of 250 mg/m2 .All patients received IMRT plus induction and/or concurrent chemotherapy.Results:With a median follow-up of 60.5 months(5 ~110 months),the 3,5-year locoregional recurrence-free survival (LRRFS),distant metastasis free survival(DMFS),progression-free survival (PFS)and overall survival(OS)were 86.1%,75.4%;79.2%,67.9%;77.8%,66.7% and 88.9%,76.7%,respectively.The 5-year PFS and OS were 83.3% and 97.1% for stageⅡ~Ⅲ patients compared with 51.7% and 58.3% for stage Ⅳ patients.Four patients experienced locoregional failure and distant metastasis occurred in 17 patients.Fourteen patients died,among them,8 died of distant metastasis.Tumor stage was a significant prognostic factor for PFS and OS(P =0.0146;P =0.0021).Grade 3 and 4 oral mucositis were found in 62.5% and 4.2% patients,respectively.Temporal lobe injure was observed in 14 patients.Conclusion:Cetuximab plus IMRT with chemotherapy for NPC is effective and the adverse events are acceptable.Prospective randomized controlled trials with larger sample size are expected in the future.