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
TANG Yuan, YI Jun-lin, GAO Li, HUANG Xiao-dong, LUO Jing-wei, LI Su-yan, XIAO Jian-ping, ZHANG Shi-ping, WANG Kai, QU Yuan, XU Guo-zhen
Department of Radiation Oncology, Cancer Hospital (Institute), Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100021, ChinaCorresponding author:YI Jun-lin, Email:yijunlin1969@yahoo.com.cn
Abstract：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.
TANG Yuan,YI Jun-lin,GAO Li et al. 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[J]. Chinese Journal of Radiation Oncology, 2013, 22(2): 139-105.
[1] Seiwert TY, Salama JK, Vokes EE. The chemoradiation paradigm in head and neck cancer. Nat Clin Pract Oncol,2007,4:156-171. [2] Pignon JP, le Maitre A, Maillard E, et al. Meta-analysis of chemotherapy in head and neck cancer (MACH-NC):an update on 93 randomised trials and 17,346 patients. Radiother Oncol,2009,92:4-14. [3] Bonner JA, Harari PM, Giralt J, et al. Radiotherapy plus cetuximab for squamous-cell carcinoma of the head and neck. N Engl J Med,2006,354:567-578. [4] Ang KK, Berkey BA, Tu X, et al. Impact of epidermal growth factor receptor expression on survival and pattern of relapse in patients with advanced head and neck carcinoma. Cancer Res,2002,62:7350-7356. [5] Egloff AM, Grandis JR. Improving response rates to EGFR-targeted therapies for head and neck squamous cell carcinoma:candidate predictive biomarkers and combination treatment with SAR inhibitors. J Oncol,2009,2009:896407. [6] Bonner JA, Harari PM, Giralt J, et al. Radiotherapy plus cetuximab for locoregionally advanced head and neck cancer:5-year survival data from a phase 3 randomised trial, and relation between cetuximab-induced rash and survival. Lancet Oncol,2010,11:21-28. [7] Blanchard P, Baujat B, Holostenco V, et al. Meta-analysis of chemotherapy in head and neck cancer (MACH-NC):a comprehensive analysis by tumour site. Radiother Oncol,2011,100:33-40. [8] 张瑜,林志安,潘建基,等.初治鼻咽癌调强放疗与常规放疗的同期对照研究.癌症,2009,(11):1143-1148. [9] Tejwani A, Wu S, Jia Y, et al. Increased risk of high-grade dermatologic toxicities with radiation plus epidermal growth factor receptor inhibitor therapy. Cancer,2009,115:1286-1299. [10] Walsh L, Gillham C, Dunne M, et al. Toxicity of cetuximab versus cisplatin concurrent with radiotherapy in locally advanced head and neck squamous cell cancer (LAHNSCC). Radiother Oncol,2011,98:38-41. [11] RTOG 0522:a randomized phase Ⅲ trial of concurrent accelerated radiation and cisplatin versus concurrent accelerated radiation, cisplatin, and cetuximab[followed by surgery for selected patients] for Stage Ⅲ and Ⅳ head and neck carcinomas. Clin Adv Hematol Oncol,2007,5:79-81. [12] Rojo F, Gracias E, Villena N, et al. Pharmacodynamic trial of nimotuzumab in unresectable squamous cell carcinoma of the head and neck:a SENDO Foundation study. Clin Cancer Res,2010,16:2474-2482. [13] Rodriguez MO, Rivero TC, Del CBR, et al. Nimotuzumab plus radiotherapy for unresectable squamous-cell carcinoma of the head and neck. Cancer Biol Ther,2010,9:343-349.
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