局部晚期鼻咽癌IMRT联合化疗±靶向治疗疗效与安全性对比

doi:10.3760/cma.j.issn.1004-4221.2016.10.003

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摘要目的回顾对比局部晚期鼻咽癌患者IMRT联合化疗±靶向治疗的疗效与不良反应，初步评价放化疗基础上加用靶向药物的必要性。方法收集2007—2012年间接受IMRT联合同步化疗±辅助化疗加靶向治疗的Ⅲ—Ⅳ_{b期鼻咽癌患者42例(试验组)，同期仅行IMRT联合同步放化疗±辅助化疗的患者与其按1∶4配对入组168例(对照组)。Kaplan-Meier法计算生存率并Logrank检验差异，余用χ²检验。结果随访率为100%，试验组、对照组3年样本量分别为42例、168例。试验组3年OS、LRFS、DMFS率分别为94%、100%、92%，对照组的分别为87.3%、94.6%、89.1%(P=0.647、0.193、0.744)。3—4级胃肠道不良反应、骨髓抑制及口腔黏膜反应发生率试验组分别为7%(3/42)、26%(11/42)、41%(17/42)，对照组分别为3.6%(6/168)、17.3%(29/168)、14.9%(25/168)(P=0.388、0.272、0.000)。结论初步结果提示IMRT联合化疗的基础上加用靶向治疗对提高局部晚期鼻咽癌患者OS、LRFS及DMFS的疗效不明显，且有可能加重放化疗相关的口腔黏膜反应。}

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	钟秋璐
	李龄
	曲颂
	陈泽昙
	梁忠国
	朱小东

关键词 ：鼻咽肿瘤/靶向疗法, 鼻咽肿瘤/调强放射疗法, 鼻咽肿瘤/化学疗法, 预后

Abstract： Objective To retrospectively compare the efficacy and toxicity between intensity-modulated radiotherapy (IMRT) combined with chemotherapy plus targeted therapy and IMRT combined with chemotherapy in the treatment of patients with locally advanced nasopharyngeal carcinoma (NPC), andto preliminarily evaluate the necessity of adding targeted drugs to standard chemoradiotherapy. Methods
Forty-two patients with stage Ⅲ-Ⅳ_b NPC who received IMRT combined with concurrent±adjuvant chemotherapy plus targeted molecular therapy from January 2007 to December 2012 were assigned to experiment group,while 168 patients who received IMRT combined with concurrent±adjuvant chemotherapy within the same period were assigned to control group. The experiment group was paired with the control group at a ratio of 1vs.4.The survival rates were caculated using Kaplan-Meier method and analyzed using log-rank method,other comparison was perfomed by χ²-test. Results The follow-up rate was 100%.The sample size of experiment group and control group were 42 patients and 168 patients. There were no significant differences in the 3-year OS, LRFS, or DMFS rates between the experiment group and the control group (94.3% vs. 87.3%, P=0.647;100.0% vs. 94.6%,P=0.193;92.2% vs. 89.1%, P=0.744).There were also no significant differences in the incidence rates of grade Ⅲ-Ⅳ gastrointestinal reaction or marrow suppression between the two groups (7.1%(3/42) vs. 3.6%(6/168),P=0.388;26.2%(11/42) vs. 17.3%(29/168),P=0.272).However,the experiment group had significantly higher incidence of grade Ⅲ-Ⅳ oral mucositis than the control group (40.5%(17/42) vs. 14.9%(25/168),P=0.000). ConclusionsThe preliminary results indicate that IMRT combined with chemotherapy plus targeted molecular therapy is not able to substantially improve the OS, LRFS, or DMFS rates in patients with locally advanced NPC. Moreover, it may aggravate radiochemotherapy-induced oral mucositis.

Key words： Nasopharyngeal neoplasms/targeted molecular therapy Nasopharyngeal neoplasms/intensity-modulated radiotherapy Nasopharyngeal neoplasms/chemotherapy Prognosis

收稿日期: 2015-11-23

基金资助:广西科学研究与技术开发计划项目(桂科攻1598012-22)

通讯作者: 朱小东,Email:zhuxiaodong83@163.com

引用本文:

钟秋璐,李龄,曲颂等. 局部晚期鼻咽癌IMRT联合化疗±靶向治疗疗效与安全性对比[J]. 中华放射肿瘤学杂志, 2016, 25(10): 1038-1042.

Zhong Qiulu,Li Ling,Qu Song et al. Comparison of efficacy and safety between intensity-modulated radiotherapy combined with chemotherapy plus targeted therapy and intensity-modulated radiotherapy combined with chemotherapy for locally advanced nasopharyngeal carcinoma[J]. Chinese Journal of Radiation Oncology, 2016, 25(10): 1038-1042.

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[1] NCCN clinical practice guidelines in oncology (Version 1.2015)[R].Washington:NCCN,2015.
[2] Chan ATC,Teo PML,Ngan RK,et al. Concurrent chemotherapy-radiotherapy compared with radiotherapy alone in locoregionally advanced nasopharyngeal carcinoma:progression-free survival analysis of a phase Ⅲ randomized trial[J].J Clin Oncol,2002,20(8):2038-2044.DOI:10.1200/JCO.2002.08.149.
[3] Feng HX,Guo SP,Li GR,et al. Toxicity of concurrent chemoradiotherapy with cetuximab for locoregionally advanced nasopharyngeal carcinoma[J].Med Oncol,2014,31(9):170.
[4] Lai SZ,Li WF,Chen L,et al. How dose intensity-modulated radiotherapy versus conventional Two-Dimensional radiotherapy influence the treatment results in nasopharyngeal carcinoma patients?[J].Radiat Oncol Biol Phys,2011,80(3):661-668.DOI:10.1016/j.ijrobp.2010.03.024.
[5] 张瑜,林志安,潘建基,等.初治鼻咽癌IMRT与常规放疗的同期对照研究[J].癌症,2009,28(11):1143-1148.
Zhang Y,Lin ZA,Pan JJ,et al. Concurrent control study of different radiotherapy for primary nasopharyngeal carcinoma,intensity-modulated radiotherapy versus conventional radiotherapy[J].Chin J Cancer,2009,28(11):1143-1148.
[6] Kam MKM,Leung SF,Zee B,et al. Prospective randomized study of intensity-modulated radiotherapy on salivary gland function in early-stage nasopharyngeal carcinoma patients[J].J Clin Oncol,2007,25(31):4873-4879.DOI:10.1200/JCO.2007.11.5501.
[7] Lee AWM,Lau WH,Tung SY,et al. Preliminary results of a randomized study on therapeutic gain by concurrent chemotherapy for regionally-advanced nasopharyngeal carcinoma:NPC-9901 trial by the Hong Kong nasopharyngeal cancer study group[J].J Clin Oncol,2005,28(1):6966-6975.DOI:10.1200/JCO.2004.00.7542.
[8] Chen L,Hu CS,Chen XZ,et al. Concurrent chemoradiotherapy plus adjuvant chemotherapy versus concurrent chemoradiotherapy alone in patients with locoregionally advanced nasopharyngeal carcinoma:a phase 3 multicentre randomised controlled trial[J].Lancet Oncol,2012,13(2):163-171.DOI:10.1016/S1470-2045(11)70320-5.
[9] Chua DT,Sham JST,Wei WI,et al. The predictive value of the 1997 American Joint Committee on Cancer stage classification in determining failure patterns in nasopharyngeal carcinoma[J].Cancer,2001,92(11):2845-2855.DOI:10.1002/1097-0142(20011201)92:11<2845::AID-CNCR10133>3.0.CO;2-7.
[10] Sultanem K,Shu HK,Xia P,et al. Three-dimensional intensity-modulated radiotherapy in the treatment of nasopharyngeal carcinoma:the University of California-San Francisco experience[J].Int J Radiat Oncol Biol Phys,2000,48(3):711-722.DOI:10.1016/S0360-3016(00)00702-1.
[11] Tate DJ,Adler Jr JR,Chang SD,et al. Stereotactic radiosurgical boost following radiotherapy in primary nasopharyngeal carcinoma:impact on local control[J].Int J Radiat Oncol Biol Phys,1999,45(4):915-921.DOI:10.1016/S0360-3016(99)00296-5.
[12] Ang KK,Berkey BA,Tu XY,et al. Impact of epidermal growth factor receptor expression on survival and pattern of relapse in patients with advanced head and neck carcinoma[J].Cancer Res,2002,62(24):7350-7356.
[13] Bonner JA,Harari PM,Giralt J,et al. Radiotherapy plus cetuximab for squamous-cell carcinoma of the head and neck cancer[J].N Eng J Med,2006,354(6):567-578.DOI:10.1056/NEJMoa053422.
[14] Niu XS,Hu CS,Kong L,et al. 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(6):1063-1071.DOI:10.1007/s00432-013-1419-z.
[15] Ramakrishnan MS,Eswaraiah A,Crombet T,et al. Nimotuzumab,a promising therapeutic monoclonal for treatment of tumors of epithelial origin[J].mAbs,2009,1(1):41-48.DOI:10.4161/mabs.1.1.7509.
[16] Ang KK,Zhang QE,Rosenthal DI,et al. A randomized phase Ⅲ trial (RTOG 0522) of concurrent accelerated radiation plus cisplatin with or without cetuximab for stage Ⅲ-Ⅳ head and neck squamous cell carcinomas (HNC)[J].J Clin Oncol,2011,29(15 Suppl):5500.
[17] Xu T,Liu Y,Dou S,et al. Weekly cetuximab concurrent with IMRT aggravated radiation-induced oral mucositis in locally advanced nasopharyngeal carcinoma:results of a randomized phase Ⅱ study[J].Oral Oncol,2015,51(9):875-879.DOI:10.1016/j.oraloncology.2015.06.008.
[18] Kapapetis CS,Khambata-Ford S,Jonker DJ,et al. K-ras mutations and benefit from cetuximab in advanced colorectal cancer[J].N Eng J Med,2008,359(17):1757-1765.DOI:10.1056/NEJMoa0804385.