Sakashita Tomohiro, Homma Akihiro, Hatakeyama Hiromitsu, Furusawa Jun, Kano Satoshi, Mizumachi Takatsugu, Iizuka Satoshi, Onimaru Rikiya, Tsuchiya Kazuhiko, Yasuda Koichi, Shirato Hiroki, Fukuda Satoshi
Department of Otolaryngology-Head & Neck Surgery .
Acta Otolaryngol. 2015 Aug;135(8):853-8. doi: 10.3109/00016489.2015.1030772. Epub 2015 Mar 26.
Grade ≥ 3 mucositis/stomatitis and inability to feed orally were problematic for patients undergoing cetuximab-based bioradiotherapy (BRT) as well as platinum-based chemoradiotherapy (CRT). Severe mucositis/stomatitis and radiation dermatitis should be addressed carefully in patients undergoing cetuximab-based BRT as well.
The efficacy of cetuximab-based BRT in locally advanced head and neck squamous cell carcinomas has been established. However, the safety of cetuximab-based BRT in comparison with platinum-based CRT is currently under investigation.
This study retrospectively analyzed 14 patients undergoing cetuximab-based BRT and 29 patients undergoing platinum-based CRT to compare the incidence of acute toxicities. In the BRT group, an initial cetuximab loading dose of 400 mg/m(2) was delivered 1 week before the start of radiotherapy. Seven weekly infusions of 250 mg/m(2) of cetuximab followed during the definitive radiotherapy. In the CRT group, cisplatin was administered at a dose of 40 mg/m(2) weekly during the definitive radiotherapy.
The BRT group had a higher incidence of Grade ≥ 3 radiation dermatitis than did the CRT group (43% vs 3%, respectively, p < 0.01). The incidence rate of Grade ≥ 3 mucositis/stomatitis was 64.3% and 41.4% in the BRT and CRT group, respectively (p = 0.1484), while the incidence rate of the inability to feed orally was 38.5% and 55.2%, respectively (p = 0.2053).
对于接受基于西妥昔单抗的生物放疗(BRT)以及基于铂类的放化疗(CRT)的患者而言,≥3级黏膜炎/口腔炎以及无法经口进食是棘手的问题。对于接受基于西妥昔单抗的BRT的患者,也应谨慎处理严重的黏膜炎/口腔炎和放射性皮炎。
基于西妥昔单抗的BRT在局部晚期头颈部鳞状细胞癌中的疗效已得到证实。然而,与基于铂类的CRT相比,基于西妥昔单抗的BRT的安全性目前正在研究中。
本研究回顾性分析了14例接受基于西妥昔单抗的BRT的患者和29例接受基于铂类的CRT的患者,以比较急性毒性的发生率。在BRT组中,放疗开始前1周给予初始西妥昔单抗负荷剂量400mg/m²。在根治性放疗期间,随后每周输注7次250mg/m²的西妥昔单抗。在CRT组中,在根治性放疗期间每周给予顺铂剂量为40mg/m²。
BRT组≥3级放射性皮炎的发生率高于CRT组(分别为43%和3%,p<0.01)。BRT组和CRT组≥3级黏膜炎/口腔炎的发生率分别为64.3%和41.4%(p=0.1484),而无法经口进食的发生率分别为38.5%和55.2%(p=0.2053)。