Concurrent Cetuximab With Stereotactic Body Radiotherapy for Recurrent Squamous Cell Carcinoma of the Head and Neck A Single Institution Matched Case-Control Study
Concurrent Cetuximab With Stereotactic Body Radiotherapy for Recurrent Squamous Cell Carcinoma of the Head and Neck A Single Institution Matched Case-Control Study
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DOI：
10.1097/coc.0b013e3181dbb73e
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发表时间：
2011-04-01
影响因子：
2.6
通讯作者：
Ferris, Robert L.
中科院分区：
文献类型：
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作者：
Heron, Dwight E.;Rwigema, Jean-Claude M.;Ferris, Robert L.
目的：局部复发的头颈部鳞状细胞癌可以通过手术挽救或再照射加或不加化疗来治疗。我们以前已经证明了立体定向身体再照射在我们的机构的可行性和安全性，但是，疗效一直不令人满意。基于西妥昔单抗联合放疗治疗局部晚期头颈部鳞状细胞癌的成功经验，我们比较了单纯立体定向体部放疗与联合治疗（同时使用西妥昔单抗和立体定向体部放疗），以提高临床疗效，同时将毒性降至最低。方法：在一项回顾性配对队列研究中，我们比较了两组仅接受立体定向体部放射治疗超过6年的患者（n = 35）或在立体定向体部放疗期间每周输注西妥昔单抗（n = 35），并评价临床反应、局部控制、总生存期和毒性。考克斯比例风险模型被用来评估独立的预后factors.Results：中位随访的患者在最后一次接触生存分别为21.3个月和24.8个月的立体定向体部放疗（n = 13）和立体定向体部放疗加西妥昔单抗（n = 22），分别。我们的研究结果表明，西妥昔单抗给予总生存优势（24.5比14.8个月）相比，立体定向体部放疗单独组，而没有显着增加3/4级毒性。这种生存优势也观察到在亚组中，接受了西妥昔单抗治疗在其先前的therapeutic regimen.Conclusions：我们的研究结果表明，伴随西妥昔单抗与立体定向体部放疗局部复发的头颈部鳞状细胞癌的总体生存的好处，并建议在这种情况下的作用。西妥昔单抗联合立体定向体部放疗是治疗不能切除的复发性头颈部鳞状细胞癌的合理方法，应在前瞻性随机试验中验证其临床疗效。
Purpose: Locally recurrent head and neck squamous cell carcinoma can be treated with curative intent by surgical salvage or reirradiation with or without chemotherapy. We have previously demonstrated the feasibility and safety of stereotactic body reirradiation at our institution; however, efficacy has been unsatisfactory. Based on the successful combination of cetuximab with radiotherapy in locally-advanced squamous cell carcinoma of the head and neck, we compared stereotactic body radiotherapy alone with combination therapy, using concomitant cetuximab with stereotactic body radiotherapy, to enhance clinical efficacy while minimizing toxicity.Methods: In a retrospective-matched cohort study, we compared 2 groups of patients treated over a 6-year period with stereotactic body radiation therapy alone (n = 35) or with weekly cetuximab infusion during stereotactic body radiotherapy (n = 35), and evaluated clinical response, local control, overall survival, and toxicity. Cox proportional hazard models were used to assess independent prognostic factors.Results: The median follow-ups for patients alive at last contact were 21.3 months and 24.8 months for stereotactic body radiotherapy only (n = 13) and stereotactic body radiotherapy plus cetuximab (n = 22), respectively. Our results indicate that cetuximab conferred an overall survival advantage (24.5 vs. 14.8 months) when compared with the stereotactic body radiotherapy alone arm, without a significant increase in grade 3/4 toxicities. This survival advantage was also observed in the subgroup that had received cetuximab therapy during their prior therapeutic regimen.Conclusions: Our results suggest an overall survival benefit of concomitant cetuximab with stereotactic body radiotherapy in locally recurrent head and neck squamous cell carcinoma, and suggest a role in this setting. Concomitant cetuximab with stereotactic body radiotherapy is a reasonable approach for unresectable recurrent squamous cell carcinoma of the head and neck, and should be tested in prospective randomized trials to validate its clinical efficacy.