Sharp Hadley, Morris John C, Van Waes Carter, Gius David, Cooley-Zgela Theresa, Singh Anurag K
Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, NIH, Bethesda, MD, USA.
Am J Clin Oncol. 2008 Dec;31(6):557-60. doi: 10.1097/COC.0b013e318172d5de.
To report a high incidence of oral mucosal dysesthesia occurring in patients on a pilot study of the epidermal growth factor receptor tyrosine kinase inhibitor gefitinib (Iressa) in combination with paclitaxel (Taxol) and external beam radiation therapy for the treatment of locally advanced squamous cell carcinoma of the head and neck.
Nine patients were enrolled on a pilot phase I trial of oral gefitinib 250 mg/d with 6 weekly doses of paclitaxel (36 or 45 mg/m) and concurrent radiation therapy [66-76 Gray (Gy)]. All had stage III/IVA-B squamous cell carcinoma of the head and neck. Patients were evaluated twice weekly by physicians and daily by nursing for adverse events.
Six of 9 patients (67%) developed a grade 3 "burning" quality oral dysesthesia. These patients received at least 50 Gy (range 50-70 Gy) to the oral tongue. The patients without grade 3 oral dysesthesia received less than 50 Gy radiation to the oral tongue. The oral dysesthesia was exacerbated by the ingestion of neutral pH liquids such as water. Of the 6 patients, all eventually developed common toxicity criteria grade 3/4 mucositis; however, symptoms continued after resolution of the mucositis. Gabapentin (Neurontin) was administered to 2 patients as a treatment for painful mucosal neuropathy. Both patients had near resolution of symptoms despite the evolution of oral mucositis.
Development of "burning"-type oral dysesthesia occurred in patients treated with the combination of gefitinib, paclitaxel, and external beam radiation of the oral tongue. This dysesthesia was improved by the use of gabapentin.
报告在一项表皮生长因子受体酪氨酸激酶抑制剂吉非替尼（易瑞沙）联合紫杉醇（泰素）及外照射放疗治疗局部晚期头颈部鳞状细胞癌的初步研究中，患者出现口腔黏膜感觉异常的高发生率。
9例患者参加了一项I期初步试验，口服吉非替尼250mg/d，每周1次，共6周，同时给予紫杉醇（36或45mg/m²）及同步放疗[66 - 76戈瑞（Gy）]。所有患者均为III/IVA - B期头颈部鳞状细胞癌。医生每周对患者进行两次评估，护士每天对患者进行评估以监测不良事件。
9例患者中有6例（67%）出现3级“烧灼样”口腔感觉异常。这些患者口腔舌部接受了至少50Gy（范围50 - 70Gy）的照射。未出现3级口腔感觉异常的患者口腔舌部接受的照射剂量低于50Gy。摄入中性pH值的液体（如水）会加重口腔感觉异常。6例患者最终均出现了常见毒性标准3/4级黏膜炎；然而，黏膜炎消退后症状仍持续。2例患者给予加巴喷丁（Neurontin）治疗疼痛性黏膜神经病变。尽管出现了口腔黏膜炎，但两名患者的症状均几乎完全缓解。
接受吉非替尼、紫杉醇联合口腔舌部外照射放疗的患者出现了“烧灼样”口腔感觉异常。加巴喷丁可改善这种感觉异常。
