西妥昔单抗联合顺铂同步三维适形调强放疗治疗初治局部晚期鼻咽癌的临床观察

摘要

Objective To explore the toierahility, safety and efficacy of cetuximab combined with cisplatin chemotherapy and concurrent intensity-modulated radiation therapy (IMRT) for the first-treated locally advanced nasopharyngeal carcinoma. Methods Eight patients with histologically proved locally advanced nasopharyngeal carcinoma admitted from August 2008 to April 2009 were treated with cetuximab combined with cisplalin chemotherapy and IMRT. Cisplatin(80mg/m2 once every 3 weeks lor 2 weeks) and eetuxi-mad(400mg/m2 once a wcek before radiation, and then 250mg/m2 per week with a total of 7-8 times) were given concurrently. The planned doses of IMRT in target region were 69. 96-73. 92Gy in 33 fractions. The lolerability, safety and efficacy were followed up. Results All patients have completed ihe treatment as planned- All following-up interval was 36 months with survival. Acute side reaction included; 8 patients all had gradelor 2 skin rash reaction, 2 cases of grade 3 bone marrow suppression, 2 cases of grade 3 oral mucositis. No toxicity of grade 4 occurred. All patients were re-examined when three months after therapy with CR in 5 patients and PR in 3 cases. Two cases had nasopharyngeal local recurrence. Both the two patients received re-process treatment with 1 case CR and I up to PR. The remaining patients were followed up for no disease progression-free survival. Conclusion The treatment of cetuximab combined with cisplalin chemotherapy and IMRT with locally advanced nasopharyngeal carcinoma has shown belter safety, tolerabilih and clinical outcome. However, the long-term efficacy needs to expand cases and further follow-up observation.%目的 探讨西妥昔单抗联合顺铂同步三维适形调强放疗(IMRT)治疗初治局部晚期鼻咽癌患者的耐受性、安全性及疗效.方法 2008年8月至2009年4月,对经病理学证实的初治局部晚期鼻咽癌8例患者采用西妥昔单抗联合顺铂同步IMRT方案治疗.同步化疗方案为:顺铂80 mg/m2,每3周1次,共2次;西妥昔单抗放疗的1周给予400mg/m2,之后每周250mg/m2,共7～8次.IMRT靶区剂量为69.96 ～73.92Gy,照射33次,随访观察患者的耐受性、安全性及疗效.结果 8例患者均按计划完成治疗,随访36个月,随访期内无1例死亡.8例患者均出现1～2级皮疹,2例3级骨髓抑制,2例3级口腔黏膜反应,无4级毒副反应发生,治疗后3个月评价,获CR5例,PR3例.2例出现鼻咽局部复发,经再程治疗后获CR和PR各1例;其余患者随访期内未出现复发.结论 对初治局部晚期鼻咽癌患者,采用西妥昔单抗联合顺铂同步IMRT治疗有较好的安全性和耐受性,近期疗效好,远期疗效待扩大病例进一步随访观察.