Radiotherapy and Radiosurgery, Humanitas Cancer Center, Istituto Clinico Humanitas, Via Manzoni 56, 20098, Rozzano (Milan), Italy.
Strahlenther Onkol. 2012 Jan;188(1):49-55. doi: 10.1007/s00066-011-0006-y. Epub 2011 Dec 24.
Cetuximab plus radiotherapy (RT) may be an effective alternative to chemoradiation in locally advanced head and neck squamous cell carcinoma (LASCCHN) patients. We analyzed a group of patients treated at our institute with cetuximab plus volumetric modulation arc therapy (VMAT) with the RapidArc technique in a simultaneous integrated boost (SIB) regime. The primary end point was the assessment of acute toxicity and the feasibility of the combined approach.
Between December 2008 and March 2010, 22 patients were submitted to IMRT-SIB plus cetuximab for radical intent in case of LASCCHN. None of the patients was suitable for chemotherapy because of important comorbidities (the majority suffered of heart chronic diseases). All patients underwent planning CT (additional image modalities were acquired for contouring purposes in the same treatment position: MRI in 12 and FDG-PET in 4 out of 22 patients). VMAT, by means of RapidArc, and SIB with two dose levels of 54.45 Gy and 69.96 Gy in 33 fractions were adopted. All patients included in the analysis were concomitantly treated with cetuximab: administration of the drug was initiated 1 week before RT at a loading dose of 400 mg/m(2) body surface area over a period of 120 min, follow by a weekly 60 min infusion of 250 mg/m(2) for the duration of RT. Patients were assessed for toxicities according to the Radiation Therapy Oncology Group (RTOG) criteria.
All but 2 patients completed treatment and achieved the minimum follow-up of 12 months after the end of the treatment. Of the 22 patients, 18% (4 patients) showed grade 1, 36% (8 patients) grade 2, and 36% (8 patients) showed grade 3 dermatitis, while 9% (2 patients) had grade 1, 36% (8 patients) grade 2, and 45% (10 patients) had grade 3 mucositis/stomatitis. No grade 4 toxicities were recorded. Considering blood parameters, 3 cases of grade 1 anemia and 1 case of grade 2 thrombocytopenia were observed. Nobody required feeding tube placement during treatment.
The here reported toxicity data are promising and encouraging in regard to the adoption of moderate hypofractionation with VMAT-SIB techniques, when cetuximab is concomitantly administered.
西妥昔单抗联合放疗（RT）可能是局部晚期头颈部鳞状细胞癌（LASCCHN）患者放化疗的有效替代方法。我们分析了一组在我们研究所接受西妥昔单抗联合容积调强弧形治疗（VMAT）和 RapidArc 技术的同时进行适形调强推量（SIB）的患者。主要终点是评估急性毒性和联合治疗的可行性。
2008 年 12 月至 2010 年 3 月，22 例局部晚期头颈部鳞状细胞癌患者接受 IMRT-SIB 联合西妥昔单抗根治性治疗。由于重要的合并症（大多数患者患有慢性心脏病），没有患者适合化疗。所有患者均行计划 CT（为同一治疗体位的轮廓勾画采集附加图像方式：MRI 12 例，FDG-PET 4 例）。采用 VMAT，通过 RapidArc，以及 54.45Gy 和 69.96Gy 的 SIB 分 33 次进行治疗。所有纳入分析的患者均同时接受西妥昔单抗治疗：在 RT 前 1 周开始给予 400mg/m2 体表面积的负荷剂量，持续 120min，然后每周输注 250mg/m2 60min，持续 RT。根据放射治疗肿瘤学组（RTOG）标准评估患者毒性。
除 2 例患者外，所有患者均完成治疗，并在治疗结束后至少随访 12 个月。22 例患者中，18%（4 例）出现 1 级皮疹，36%（8 例）出现 2 级皮疹，36%（8 例）出现 3 级皮炎，9%（2 例）出现 1 级口腔炎/黏膜炎，36%（8 例）出现 2 级口腔炎/黏膜炎，45%（10 例）出现 3 级口腔炎/黏膜炎。无 4 级毒性反应。考虑到血液参数，观察到 3 例 1 级贫血和 1 例 2 级血小板减少。治疗期间无人需要放置喂养管。
在联合西妥昔单抗的情况下，采用 VMAT-SIB 技术进行适度的亚分次治疗，这里报告的毒性数据是有希望和令人鼓舞的。
