立体定向体部放疗联合西妥昔单抗治疗既往放疗不可切除的头颈部癌症。
Stereotactic body radiotherapy plus cetuximab for previously irradiated un-resectable head and neck cancer.
机构信息
Department of Hematology-Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan.
出版信息
Biomed J. 2022 Oct;45(5):838-846. doi: 10.1016/j.bj.2021.10.013. Epub 2021 Nov 5.
BACKGROUND
The aim of the study was to explore the treatment outcomes and prognostic factors for patients with previously irradiated but unresectable recurrent head and neck squamous cell carcinoma (rHNSCC) treated by stereotactic body radiotherapy (SBRT) plus cetuximab at a single institute in Taiwan.
METHODS
From February 2016 to March 2019, 74 patients with previously irradiated but unresectable rHNSCC were treated with SBRT plus cetuximab. All patients received irradiation to the gross tumor and/or nodal area with 40-50 Gy in five fractions, with each fraction interval ≥2 days over a 2-week period by using the CyberKnife M6 machine. AnF-fluorodeoxyglucose positron emission tomography-computed tomography (PET-CT) scan was performed before treatment for treatment target delineation (n = 74) and 2 months later for response evaluation (n = 60). The median follow-up time was 9 months (range 1-36 months).
RESULTS
The treatment response rate was complete response: 25.0%, partial response: 41.7%, stable disease: 11.7%, and progressive disease: 21.7% based on the criteria of the Response Evaluation Criteria in Solid Tumors (n = 72) and complete metabolic response: 21.7%, partial metabolic response: 51.7%, stable metabolic disease: 13.3%, and progressive metabolic disease: 13.3% based on PET-CT (n = 60), respectively. The 1-/2-year overall survival (OS) and progression-free survival (PFS) rates were 42.8%/22.0% and 40.5%/19.0%, respectively. In the logistic regression model, a re-irradiation interval >12 months was observed to be the only significant prognostic factor for a favorable treatment response. In the Cox proportional hazards model, a re-irradiation interval >12 months and gross tumor volume (GTV) ≦ 50 ml were favorable prognostic factors of OS and PFS.
CONCLUSION
SBRT plus cetuximab provides a promising salvage strategy for those patients with previously irradiated but unresectable rHNSCC, especially those with a re-irradiation interval >12 months or GTV ≦ 50 ml.
背景
本研究旨在探讨在台湾的一家机构中，对接受过放疗但无法切除的复发性头颈部鳞状细胞癌（rHNSCC）患者采用立体定向体部放疗（SBRT）加西妥昔单抗治疗的治疗结果和预后因素。
方法
从 2016 年 2 月至 2019 年 3 月，74 例接受过放疗但无法切除的 rHNSCC 患者接受了 SBRT 加西妥昔单抗治疗。所有患者均采用 CyberKnife M6 机器，以 40-50Gy 的 5 个分数进行照射，每个分数间隔≥2 天，共 2 周，对大体肿瘤和/或淋巴结区域进行照射。在治疗前（n=74）和 2 个月后（n=60）进行治疗靶区勾画时进行氟-18-脱氧葡萄糖正电子发射断层扫描-计算机断层扫描（PET-CT）扫描，以评估治疗反应。中位随访时间为 9 个月（1-36 个月）。
结果
根据实体瘤反应评价标准（n=72），治疗反应率为完全缓解：25.0%，部分缓解：41.7%，稳定疾病：11.7%，进展性疾病：21.7%；基于 PET-CT（n=60），完全代谢反应：21.7%，部分代谢反应：51.7%，稳定代谢疾病：13.3%，进展代谢疾病：13.3%。1/2 年总生存率（OS）和无进展生存率（PFS）分别为 42.8%/22.0%和 40.5%/19.0%。在逻辑回归模型中，观察到再放疗间隔>12 个月是治疗反应良好的唯一显著预后因素。在 Cox 比例风险模型中，再放疗间隔>12 个月和肿瘤体积（GTV）≦50ml 是 OS 和 PFS 的有利预后因素。
结论
SBRT 加西妥昔单抗为接受过放疗但无法切除的 rHNSCC 患者提供了一种有前途的挽救策略，特别是对于再放疗间隔>12 个月或 GTV≦50ml 的患者。
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