[an error occurred while processing this directive]|[an error occurred while processing this directive]
鼻咽癌IMRT同期EGFR单抗和同期化疗与单纯IMRT的回顾对照研究
尹珍珍,易俊林,黄晓东,罗京伟,王凯,高黎,曲媛,张世平,肖建平,徐国镇
100021 北京协和医学院中国医学科学院肿瘤医院放疗科
Clinical effects of IMRT combined with EGFR monoclonal antibody, concurrent chemoradiotherapy, and IMRT alone in nasopharyngeal carcinoma patients:a retrospective case-control study
Yin Zhenzhen, Yi Junlin, Huang Xiaodong, Luo Jingwei, Wang Kai,Gao Li, Qu Yuan, Zhang Shiping, Xiao Jianping, Xu Guozhen.
Department of Radiation Oncology, Cancer Hospital, Chinese Academy of Medical Science, Peking Union Medical College, Beijing 100021, China
Abstract：Objective To compare the treatment outcomes and toxicities in nasopharyngeal carcinoma patients who receive intensity-modulated radiotherapy (IMRT) combined with epidermal growth factor receptor (EGFR) monoclonal antibody, IMRT with concurrent chemotherapy, and IMRT alone. Methds Sixty-eight previously untreated patients with stage Ⅱ-IVb nasopharyngeal carcinoma (NPC) who received IMRT combined with cetuximab or nimotuzumab from January 2008 to September 2012 were included in BRT group;the BRT group was matched with 136 patients treated with concurrent chemoradiotherapy (CCRT) and 136 patients treated with IMRT alone at a ratio of 1∶2 using SAS software. The Kaplan-Meier method was used for calculating survival rates, and the log-rank test was used for survival difference analysis. Prognostic factors were analyzed by the Cox model. Results The sample sizes of the BRT group, IMRT group, and CCRT group were 14,69,47, respectively. The 3-year overall survival (OS), disease-free survival (DFS), locoregional control (LRC), and distant metastasis-free survival (DMFS) of all patients were 91.2%, 80.2%, 93.1%, and 87.2%, respectively. The 3-year OS rates of BRT group, IMRT group, and CCRT group were 91.9%, 92.1%, and 89.9%, respectively (P=0.379);the 3-year DFS rates of BRT group, IMRT group, and CCRT group were 82.1%, 77.9%, and 81.6%, respectively (P=0.594);the 3-year LRC rates of BRT group, IMRT group, and CCRT group were 98.2%, 90.6%, and 93.0%, respectively (P=0.249);the 3-year DMFS rates of BRT group, IMRT group, and CCRT group were 85.2%, 85.2%, and 90.3%, respectively (P=0.383). Multivariate prognostic analysis showed that T stage and concurrent use of EGFR monoclonal antibody were influential factors for LRC (P=0.034 and 0.032). Conclusions IMRT alone yields a good treatment outcome in NPC patients. Although there were no significant differences in OS between the three groups, the BRT group showed an increasing trend in LRC.
Yin Zhenzhen,Yi Junlin,Huang Xiaodong et al. Clinical effects of IMRT combined with EGFR monoclonal antibody, concurrent chemoradiotherapy, and IMRT alone in nasopharyngeal carcinoma patients:a retrospective case-control study[J]. Chinese Journal of Radiation Oncology, 2014, 23(6): 495-499.
[1] Baujat B, Audry H, Bourhis J, et al. Chemotherapy in locally advanced nasopharyngeal carcinoma:an individual patient data meta-analysis of eight randomized trials and 1753 patients[J]. Int J Radiat Oncol Biol Phys,2006,64:47-56. [2] 易俊林,高黎,黄晓东,等.416例鼻咽癌调强放疗远期生存与影响因素分析[J].中华放射肿瘤学杂志,2012,21:196-200. [3] Ma BB, Kam MK, Leung SF, et al. A phase II study of concurrent cetuximab-cisplatin and intensity-modulated radiotherapy in locoregionally advanced nasopharyngeal carcinoma[J]. Ann Oncol,2012,23:1287-1292. [4] Niu X, Hu C, Kong L. Experience with combination of cetuximab plus intensity-modulated radiotherapy with or without chemotherapy for locoregionally advanced nasopharyngeal carcinoma[J].J Cancer Res Clin Oncol,2013,139:1063-1071. [5] 高黎,易俊林,黄晓东,等.鼻咽癌根治性放疗10年经验总结[J].中华放射肿瘤学杂志,2006,15:249-256. [6] Cao CN, Luo JW, Gao L, et al. Clinical outcomes and patterns of failure after intensity-modulated radiotherapy for T4 nasopharyngeal carcinoma[J]. Oral Oncol,2013,49:175-181. [7] Sun W, Long G, Wang J, et al. Prognostic role of epidermal growth factor receptor in nasopharyngeal carcinoma:a meta-analysis[J]. Head Neck,2014,In press. [8] Chan AT, Hsu MM, Goh BC, et al. Multicenter, phase II study of cetuximab in combination with carboplatin in patients with recurrent or metastatic nasopharyngeal carcinoma[J]. J Clin Oncol,2005,23:3568-3576. [9] Mason KA, Komaki R, Cox JD, et al. Biology-based combined-modality radiotherapy:workshop report[J]. Int J Radiat Oncol Biol Phys,2001,50:1079-1089. [10] 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[J]. Lancet Oncol,2010,11:21-28. [11] Chen CY, Zhao C, Gao L. An open-labeled, multicentric clinical study of cetuximab combined with intensity-modulated radiotherapy (IMRT) plus concurrent chemotherapy in locoregionally advanced nasopharyngeal carcinoma (NPC):a 2-year follow-up report. J Clin Oncol,2012,30 Suppl 15:abs5535. [12] 黄晓东,易俊林,高黎,等.抗表皮生长因子受体单克隆抗体h-R3联合放疗治疗晚期鼻咽癌的Ⅱ期临床研究[J].中华肿瘤杂志,2007,29:197-201.
2014, Vol. 23 
