Balermpas Panagiotis, Hambek Markus, Seitz Oliver, Rödel Claus, Weiss Christian
Department of Radiation Therapy and Oncology, Goethe University, Frankfurt/Main, Germany.
Strahlenther Onkol. 2009 Dec;185(12):775-81. doi: 10.1007/s00066-009-2092-7.
To investigate the feasibility, toxicity, and efficacy of external-beam reirradiation (Re-RT) combined with cetuximab for patients with inoperable and recurrent squamous cell carcinoma of the head and neck (SCCHN).
Seven patients with inoperable recurrence of SCCHN after adjuvant or definitive radiotherapy (RT) and simultaneous or sequential cisplatin-based chemotherapy for primary SCCHN were treated between August and December 2008 with Re-RT (1.8 Gy/fraction to 50.4 Gy) and cetuximab (400 mg/m(2) initial dose in the 1st week, and then 250 mg/m(2) once weekly). Recurrence had to be located at least > or = 50% in the preirradiated field. Long term toxicity from previous treatment was recorded before Re-RT as a baseline value. Acute and late toxicity derived from the experimental regimen were recorded every week during RT, and then every 3 months. Efficacy was assessed with repeated imaging using response evaluation criteria in solid tumors (RECIST) and clinical examinations 8-12 weeks after end of the treatment and every 3 months thereafter (Tables 1 and 2).
Only mild localized mucositis occurred in all patients. Two patients developed a grade 3 acneiform rash related to cetuximab. After treatment one patient developed a grade 2 trismus, another showed grade 3 abacterial salivary gland inflammation with severe pain requiring opioid medication. Two patients achieved a complete response after 7 months, one remained stable, three progressed, and one died from pneumonia without having restaging magnetic resonance imaging.
A second course of RT combined with cetuximab in patients with inoperable, recurrent HNSCC proved to be feasible with mild or moderate toxicity and encouraging response to treatment.
探讨外照射再程放疗（Re-RT）联合西妥昔单抗治疗不可手术切除的复发性头颈部鳞状细胞癌（SCCHN）患者的可行性、毒性及疗效。
2008年8月至12月，对7例在辅助或根治性放疗（RT）及同步或序贯铂类化疗治疗原发性SCCHN后出现不可手术切除复发的患者进行了Re-RT（1.8 Gy/分次，共50.4 Gy）及西妥昔单抗治疗（第1周初始剂量400 mg/m²，之后每周1次250 mg/m²）。复发部位必须至少有≥50%位于先前放疗野内。在Re-RT前记录先前治疗的长期毒性作为基线值。在放疗期间每周记录实验方案引起的急性和晚期毒性，之后每3个月记录1次。在治疗结束后8 - 12周及之后每3个月，使用实体瘤疗效评价标准（RECIST）进行重复影像学检查及临床检查来评估疗效（表1和表2）。
所有患者仅出现轻度局限性黏膜炎。2例患者出现与西妥昔单抗相关的3级痤疮样皮疹。治疗后1例患者出现2级牙关紧闭，另1例表现为3级无菌性唾液腺炎症伴严重疼痛，需要使用阿片类药物。2例患者在7个月后达到完全缓解，1例病情稳定，3例进展，1例死于肺炎，未进行再分期磁共振成像检查。
对于不可手术切除的复发性头颈部鳞状细胞癌患者，第二疗程放疗联合西妥昔单抗治疗被证明是可行的，毒性为轻度或中度，且治疗反应令人鼓舞。
