Department of Academic Radiotherapy, Centre Oscar Lambret and University Lille II, Lille, France.
Int J Radiat Oncol Biol Phys. 2012 Sep 1;84(1):203-9. doi: 10.1016/j.ijrobp.2011.11.054. Epub 2012 Feb 11.
Normal tissues tolerance limits the use of reirradiation for recurrent head-and-neck cancers (HNC). Stereotactic body radiotherapy (SBRT) could offer precise irradiation while sparing healthy tissues. Results of a feasibility study using SBRT with or without cetuximab are reported for reirradiation of recurrent primary HNC.
Patients with inoperable recurrent, or new primary tumor, in a previously irradiated area were included. Reirradiation dose was 36 Gy in six fractions of 6 Gy to the 85% isodose line covering 95% of the planning target volume. Patients with squamous cell carcinoma received concomitant cetuximab.
Between June 2007 and January 2010, 40 patients were prospectively treated for 43 lesions. Median age was 60 and median tumor size was 29 mm. Fifteen patients received concomitant cetuximab and 1 received concomitant cisplatin. Median follow-up was 25.6 months with 34 patients evaluable for tumor response. Median overall survival was 13.6 months and response rate was 79.4% (15 complete and 12 partial responses). Grade 3 toxicity occurred in 4 patients.
These results suggest that short SBRT with or without cetuximab is an effective salvage treatment with good response rate in this poor prognosis population with previously irradiated HNC. Treatment is feasible and, with appropriate care to limiting critical structure, acute toxicities are acceptable. A prospective multicenter Phase II trial of SRT and concomitant cetuximab in recurrent HNC squamous cell carcinoma is ongoing.
正常组织耐受限制了再放疗在复发性头颈部癌症（HNC）中的应用。立体定向体部放疗（SBRT）可以提供精确的照射，同时保护健康组织。本文报告了使用 SBRT 联合或不联合西妥昔单抗治疗复发性原发性 HNC 的可行性研究结果。
纳入了无法手术切除的复发性或新原发性肿瘤患者，这些肿瘤位于先前照射过的区域。再放疗剂量为 36 Gy，6 Gy/次，共 6 次，85%等剂量线覆盖 95%的计划靶区。鳞状细胞癌患者接受西妥昔单抗同步治疗。
2007 年 6 月至 2010 年 1 月，40 例患者的 43 个病灶接受了前瞻性治疗。中位年龄为 60 岁，中位肿瘤大小为 29mm。15 例患者接受了西妥昔单抗同步治疗，1 例患者接受了顺铂同步治疗。中位随访时间为 25.6 个月，34 例患者可评估肿瘤反应。中位总生存期为 13.6 个月，总缓解率为 79.4%（15 例完全缓解，12 例部分缓解）。4 例患者出现 3 级毒性。
这些结果表明，短程 SBRT 联合或不联合西妥昔单抗是一种有效的挽救治疗方法，在先前接受过放疗的 HNC 这一预后较差的人群中，反应率较高。治疗是可行的，只要适当注意限制关键结构，急性毒性是可以接受的。一项在复发性 HNC 鳞状细胞癌中使用 SRT 联合西妥昔单抗的前瞻性多中心 II 期试验正在进行中。
