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目的:分析西妥昔单抗联合适形调强放疗和化疗治疗鼻咽癌的临床疗效,毒性反应和预后因素。方法:纳入2006年3月至2011年3月在我院初治,无远处转移的Ⅱ~Ⅳ期鼻咽癌共72例。西妥昔单抗初始剂量为400 mg/m~2,之后为每周250 mg/m~2。所有患者接受适形调强放疗,接受诱导和/或同步化疗。结果:中位随访60.5月(5~110月)。全组患者3年、5年无局部区域复发生存率(local regional recurrence-free survival,LRRFS)、无远处转移生存率(distant metastasis free-survival,DMFS)、无进展生存率(progression-free survival,PFS);总生存率(overall survival,OS)分别为86.1%,75.4%;79.2%,67.9%;77.8%,66.7%和88.9%,76.7%。Ⅱ~Ⅲ期和Ⅳ期患者的5年PFS及OS分别为83.3%,97.1%和51.7%,58.3%。4例患者出现局部区域复发,共有17例患者出现远处转移。死亡14例患者中8例死于单纯远处转移。单因素分析显示肿瘤分期为PFS和OS的预后因素(P=0.0146,P=0.0021)。分别有62.5%和4.2%患者发生3和4级口腔粘膜炎。14例患者出现颞叶损伤。结论:西妥昔单抗联合IMRT加化疗治疗鼻咽癌的临床疗效较好,毒性反应可耐受。值得扩大样本量以及开展前瞻性随机对照试验进一步研究。
OBJECTIVE: To analyze the clinical efficacy, toxicity and prognostic factors of cetuximab in combination with CRT and chemotherapy for nasopharyngeal carcinoma. Methods: A total of 72 patients with stage Ⅱ ~ Ⅳ nasopharyngeal carcinoma were included in our hospital from March 2006 to March 2011. Cetuximab initial dose of 400 mg / m ~ 2, followed by 250 mg / m ~ 2 per week. All patients underwent IMRT and received induction and / or concurrent chemotherapy. Results: The median follow-up 60.5 months (5 ~ 110 months). All patients were followed up for 3 years and 5 years without local regional recurrence-free survival (LRRFS), distant metastasis free survival (DMFS), progression-free survival , PFS). The overall survival (OS) was 86.1%, 75.4%, 79.2%, 67.9%, 77.8%, 66.7%, 88.9%, 76.7% respectively. The 5-year PFS and OS of stage II-III and IV were 83.3%, 97.1% and 51.7%, 58.3%, respectively. Four patients had local recurrence, and 17 patients had distant metastasis. Of the 14 patients who died, 8 died of simple distant metastases. Univariate analysis showed that the tumor stage was prognostic factor for PFS and OS (P = 0.0146, P = 0.0021). There were 62.5% and 4.2% of patients with grade 3 and 4 oral mucositis respectively. Twenty-four patients had temporal lobe injury. Conclusion: Cetuximab combined with IMRT plus chemotherapy in the treatment of nasopharyngeal carcinoma has good clinical efficacy and tolerability of toxic reactions. It is worth expanding the sample size and conducting prospective randomized controlled trials for further study.