Department of Radiation Oncology, University of Heidelberg, Heidelberg, Germany.
Strahlenther Onkol. 2011 Jan;187(1):32-8. doi: 10.1007/s00066-010-2149-7. Epub 2010 Dec 23.
In this retrospective investigation, the outcome and toxicity after reirradiation with concurrent cetuximab immunotherapy of recurrent head and neck cancer (HNC) in patients who had contraindications to platinum-based chemotherapy were analyzed.
Ten patients with locally advanced recurrent HNC were retrospectively evaluated. In 9 cases, histology was squamous cell carcinoma, in one case adenoid cystic carcinoma. External beam radiotherapy was part of the initial treatment in all cases. Reirradiation was carried out using step-and-shoot intensity-modulated radiotherapy (IMRT) with a median dose of 50.4 Gy. Cetuximab was applied as loading dose (400 mg/m(2)) 1 week prior to reirradiation and then weekly concurrently with radiotherapy (250 mg/m(2)).
The median overall survival time after initiation of reirradiation was 7 months; the 1-year overall survival (OS) rate was 40%. Local failure was found in 3 patients, resulting in a 1-year local control (LC) rate of 61%. The 1-year locoregional control (LRC) rate was 44%, while the 1-year distant metastasis-free survival (DMFS) was 75%. Acute hematological toxicity was not observed in the group. Severe acute toxicity included one fatal infield arterial bleeding and one flap necrosis. Severe late toxicities were noted in 2 patients: fibrosis of the temporomandibular joint in 1 patient and stenosis of the cervical esophagus in another.
IMRT reirradiation with concurrent cetuximab immunotherapy in recurrent HNC is feasible with acceptable acute toxicity. Further investigations are necessary to determine the clinical role of this therapy concept.
在这项回顾性研究中，分析了因对铂类化疗有禁忌而无法接受该治疗的复发性头颈部癌症（HNC）患者，采用顺铂免疫治疗同步再放疗的疗效和毒性。
对 10 例局部晚期复发性 HNC 患者进行回顾性评估。9 例组织学为鳞状细胞癌，1 例为腺样囊性癌。所有病例初始治疗均采用外照射放疗。再放疗采用分割步进调强放疗（IMRT），中位剂量为 50.4 Gy。在再放疗前 1 周给予西妥昔单抗负荷剂量（400 mg/m2），然后每周与放疗同时应用（250 mg/m2）。
从开始再放疗到死亡的中位总生存时间为 7 个月；1 年总生存率（OS）为 40%。3 例患者出现局部失败，导致 1 年局部控制率（LC）为 61%。1 年局部区域控制率（LRC）为 44%，1 年无远处转移生存率（DMFS）为 75%。该组未观察到急性血液学毒性。严重急性毒性包括 1 例场内动脉出血致死和 1 例皮瓣坏死。2 例患者出现严重晚期毒性：1 例为颞下颌关节纤维化，另 1 例为颈段食管狭窄。
复发性 HNC 采用 IMRT 再放疗联合西妥昔单抗免疫治疗具有可接受的急性毒性，这一治疗方案的临床作用还需要进一步研究确定。
