Concurrent Cetuximab and Radiation Therapy in Patients with Locoregionally Advanced Head and Neck Cancer

Full Article

HC Cheng, RKC Ngan, KH Au

Hong Kong J Radiol 2012;15:29-35

Objective: To retrospectively study the clinical characteristics and treatment outcomes in patients with locoregionally advanced head and neck cancer treated concurrently with cetuximab and radiotherapy.

Methods: Patients with locoregionally advanced head and neck cancer treated between May 2008 and July 2010 were evaluated. Cetuximab was initiated one week before and then weekly during radiotherapy treatment. The majority of patients were prescribed a radiotherapy dose of 70 Gy.

Results:The age of 31 patients ranged from 45 to 84 (median, 67) years and 77% were male. The majority (65%) had comorbid diseases and 35% had a Karnofsky performance status score of 70 or less. In all, 30 patients had squamous cell carcinoma and one had undifferentiated carcinoma. Primary tumour sites were larynx (n = 12), oropharynx (n = 8), oral cavity (n = 7), hypopharynx (n = 3), and maxillary sinus (n = 1). Follow-up times ranged from 5 to 31 (median, 16) months. Response rate was 80% (complete remission, 64%; partial remission, 16%). Median duration of locoregional control was not reached (1-year and projected 2-year locoregional control rates were 70% and 55%, respectively). Median progression-free survival was 13 months (1-year and projected 2-year progression-free survival rates were 51% and 40%, respectively). Median overall survival was 25 months (1-year and projected 2-year overall survival rates were 65% and 60%, respectively). Treatment toxicities of grade 3 or more included oral mucositis (52%), radiation dermatitis (26%), and infection (13%). The majority of patients (84%) received eight doses of cetuximab.

Conclusion: Cetuximab given concurrently with radiotherapy was well-tolerated and not associated with a significant increase in the frequency or severity of radiotherapy-induced mucositis and dermatitis. Our data demonstrated favourable tumour response rates and locoregional control duration comparable to that in the pivotal Bonner study.






方法:本研究評估2008年5月至2010年7月期間的局部晚期頭頸癌患者。在進行放射治療前一星期,患者先接受西妥昔單抗注射,再在放射治療期間每星期注射一次。大部分病人接受70 Gy的放射治療 劑量。

結果:31名病人年齡介乎45至84歲,中位數67歲;77%為男性。大部分(65%)患者同時患有其他疾 病,35%患者的化療前Karnofsky體力狀況為70分或以下。30例為鱗狀細胞癌,另1例為未分化癌。原 發灶的位置分別為:喉12例、口咽8例、口腔7例、下咽3例、上頷竇1例。跟進期介乎5至31個月,中 位數16個月。治療反應率為80%,其中64%屬完全緩解,16%屬部分緩解。病人未達局部區域控制的 中位期;一年及預測兩年的局部區域控制率分別為70%及55%。病情無惡化生存期中位數為13個月; 一年及預測兩年的病情無惡化生存率分別為51%及40%。總生存期中位數為25個月;一年及預測兩 年的總生存率分別為65%及60%。治療毒性達三級或以上的包括有口腔黏膜炎(52%)、輻射性皮炎 (26%)及感染(13%)。大部分患者接受8個劑量的西妥昔單抗。

結論:西妥昔單抗和放療的聯合治療的耐受性好,放射治療引致的口腔黏膜炎及皮炎的頻率和嚴重 性並無增加。與Bonner研究比較,本研究所得的結果顯示無論在腫瘤反應率及局部控制率方面均得 到相約療效。