Bölke Edwin, Gerber Peter Arne, Lammering Guido, Peiper Matthias, Müller-Homey Anja, Pape Hildegard, Giro Christian, Matuschek Christiane, Bruch-Gerharz Daniela, Hoffmann Thomas K, Gripp Stephan, Homey Bernhard, Budach Wilfried
Department of Radiation Oncology, University of Duesseldorf, Germany.
Strahlenther Onkol. 2008 Feb;184(2):105-10. doi: 10.1007/s00066-008-1829-z.
The concurrent administration of cetuximab to radiotherapy has recently been shown to improve the clinical outcome of head-and-neck cancer (HNC) patients. An aggravation of the radiation-induced skin toxicity was not described. Here, however, two cases with severe skin toxicity during the combined treatment are reported.
In a small group of five patients with locally advanced HNC treated with irradiation and concurrent cetuximab, two cases of unusually severe radiation dermatitis were observed. Both patients developed confluent moist desquamations confined to the irradiation field at a dose of 40 Gy (CTC [Common Toxicity Criteria] grade 3), which progressed into an ulcerative dermatitis (grade 4) at 58 Gy and 46 Gy, respectively. Histopathology showed a vacuolic degeneration of basal keratinocytes, subepidermal blister formation, and mixed perivascular and interstitial inflammatory infiltrates leading to a complete loss of the epidermis. These cutaneous side effects led to the discontinuation of radiotherapy. Topical corticosteroids and systemic antibiotic treatment resulted in wound healing, which allowed the continuation of radiotherapy.
These findings indicate that cetuximab may have the potential to enhance the severity of radiation dermatitis in HNC patients. A systematic monitoring of cutaneous side effects during radiotherapy plus cetuximab is advised in order to reliably estimate the frequency of severe (grade 3/4) radiation dermatitis.
近期研究表明，西妥昔单抗与放疗联合应用可改善头颈部癌（HNC）患者的临床疗效。此前未见有关于放疗引起的皮肤毒性加重的报道。然而，本文报告了两例在联合治疗期间出现严重皮肤毒性的病例。
在一小群接受放疗及西妥昔单抗同步治疗的五例局部晚期HNC患者中，观察到两例异常严重的放射性皮炎。两名患者均在40 Gy剂量时，照射野出现融合性湿性脱皮（通用毒性标准[CTC]3级），分别在58 Gy和46 Gy时进展为溃疡性皮炎（4级）。组织病理学显示基底角质形成细胞空泡变性、表皮下疱形成，以及血管周围和间质混合性炎性浸润，导致表皮完全缺失。这些皮肤副作用导致放疗中断。局部使用皮质类固醇和全身抗生素治疗使伤口愈合，从而得以继续放疗。
这些发现表明，西妥昔单抗可能会加重HNC患者放射性皮炎的严重程度。建议在放疗加用西妥昔单抗期间对皮肤副作用进行系统监测，以便可靠地评估严重（3/4级）放射性皮炎的发生率。
