放射性免疫治疗腺样囊性癌：西妥昔单抗联合治疗的单中心系列研究。

BACKGROUND

Local control in adjuvant/definitive RT of adenoid cystic carcinoma (ACC) is largely dose-dependent. However, some clinical situations do not allow application of tumouricidal doses (i.e. re-irradiation) hence radiation sensitization by exploitation of high endothelial growth factor receptor (EGFR)-expression in ACC seems beneficial. This is a single-institution experience of combined radioimmunotherapy (RIT) with the EGFR-inhibitor cetuximab.

METHODS

Between 2006 and 2010, 9 pts received RIT for advanced/recurrent ACC, 5/9 pts as re-irradiation. Baseline characteristics as well as treatment parameters were retrieved to evaluate efficacy and toxicity of the combination regimen were evaluated. Control rates (local/distant) and overall survival were calculated using Kaplan-Meier estimation.

RESULTS

Median dose was 65 Gy, pts received a median of 6 cycles cetuximab. RIT was tolerated well with only one °III mucositis/dysphagia. Overall response/remission rates were high (77,8%); 2-year estimate of local control was 80% hence reaching local control levels comparable to high-dose RT. Progression-free survival (PFS) at 2 years and median overall survival were only 62,5% and 22,2 mo respectively.

CONCLUSION

While local control and treatment response in RIT seems promising, PFS and overall survival are still hampered by distant failure. The potential benefit of RIT with cetuximab warrants exploration in a prospective controlled clinical trial.

背景

在腺样囊性癌（ACC）的辅助/根治性放疗中，局部控制在很大程度上取决于剂量。然而，在某些临床情况下，无法应用肿瘤杀伤剂量（即再放疗），因此通过利用 ACC 中高内皮生长因子受体（EGFR）的表达来进行放射增敏似乎是有益的。这是一项关于联合放射免疫治疗（RIT）与 EGFR 抑制剂西妥昔单抗治疗晚期/复发性 ACC 的单机构经验。

方法

在 2006 年至 2010 年间，9 名患者接受了 RIT 治疗晚期/复发性 ACC，其中 5/9 名患者为再放疗。回顾了基线特征和治疗参数，以评估联合治疗方案的疗效和毒性。使用 Kaplan-Meier 估计法计算控制率（局部/远处）和总生存率。

结果

中位剂量为 65 Gy，患者接受了中位 6 个周期的西妥昔单抗治疗。RIT 耐受性良好，仅有 1 例出现 III 级黏膜炎/吞咽困难。总体反应/缓解率较高（77.8%）；2 年局部控制率估计为 80%，因此达到了与高剂量 RT 相当的局部控制水平。2 年无进展生存率（PFS）和中位总生存率分别为 62.5%和 22.2 个月。