Preliminary Results of Induction Bio-Chemotherapy followed by Intensity-modulated Radiotherapy for Advanced Nasopharyngeal Carcinoma

晚期鼻咽癌接受誘導化療合併標靶治療隨後強度調控放射治療之初步結果

劉怡君(Yi-Chun Liu) ； 林伯儒(Po-Ju Lin) ； 謝合原(He-Yuan Hsieh) ； 林敬薇(Jing-Wei Lin) ； 林進清(Jin-Ching Lin)

《放射治療與腫瘤學》 25卷2期 (2018/06) Pp. 65-74

https://doi.org/10.6316/TRO.201806_25(2)0001

摘要

Purpose: To investigate the efficacy and toxicity of induction bio-chemotherapy followed by intensity-modulated radiotherapy (IMRT) for advanced nasopharyngeal carcinoma (NPC) patients. Materials and Methods: Twenty-five patients with previously untreated, stage III/IV NPC received induction bio-chemotherapy followed by IMRT. Induction chemotherapy consists of weekly P-FL (cisplatin + 5-fluorouracil) doublet (n= 17) or a triplet of P-FL-G (P-FL + gemcitabine, n= 7) or P-FL-D (P-FL + docetaxel, n= 1) for a total of 10-12 weeks. Cetuximab 400 mg/m^2 day 1, then 250 mg/m^2 were administered every week. IMRT 70 Gy/35 fractions were delivered to T1-3 lesions and 74 Gy/37 fractions or 76.8 Gy/64 fractions to the T4 tumor. Results: Baseline characteristics are median age= 44 year-old; male/female= 19/6; performance status ECOG 0/1= 13/12; stage III/IV= 12/13, and pathological type (WHO) IIa/IIb= 12/13. All patients tolerated induction bio-chemotherapy very well. Grade 3 toxicity included leucopenia (8.0%) and skin rashes (40.0%). There was no grade 4 toxicity. After induction bio-chemotherapy, we obtained 52.0% complete response rate and 48.0% partial response rate. Thirteen of 24 (54.2%) patients who received re-biopsy of the nasopharynx before IMRT were reported as no viable tumor. IMRT was performed smoothly with a median treatment time of 49 days (range 45-53). After a median follow-up of 21 months, we observed 4 treatment failures, all in distant sites. The 2-year rates overall survival, locoregional failure-free and distant failure-free survivals were 100%, 100%, and 80%, respectively. Conclusion: Induction chemotherapy plus concurrent weekly cetuximab followed by IMRT is a highly effective protocol with very low toxicity in advanced NPC.

關鍵字

Nasopharyngeal carcinoma ； Induction chemotherapy ； Cetuximab ； Radiotherapy

並列摘要

目的：探討晚期鼻咽癌患者接受誘導化療合併標靶治療，隨後接受強度調控放療的療效和毒性。材料和方法：本研究收錄新診斷的第三、四期鼻咽癌患者25名，接受誘導化療合併標靶治療，隨後進行強度調控放療。誘導化療為P-FL二藥聯合處方（順鉑加5-氟尿嘧啶，17例）、或三藥聯合處方P-FL-G（P-FL加健擇，7例）或P-FL-D（P-FL加歐洲紫杉醇，一例），每週一種化藥共給10-12週。在誘導化療期間同時給爾必得舒（Cetuximab）400 mg/m^2第1天，然後每週給250 mg/m^2。強度調控放療劑量為巨觀腫瘤體積給予70 Gy/35分次（T1-3之病患），74 Gy/37分次或76.8 Gy/64分次（每次1.2 Gy，一天照射二次，T4腫瘤病患）。結果：病人的中位數年齡為44歲；男性/女性= 19/6；病人一般狀況ECOG 0/1=13/12；臨床分期第三/四期= 12/13，病理類型（WHO分型）IIa/IIb = 12/13。所有患者對誘導化療合併標靶治療耐受性良好。第3級毒性反應只有8.0%白血球低下和40.0%皮疹，沒有發生第4級毒性反應。誘導化療合併標靶治療後，評估療效有52.0%完全緩解率和48.0％部分緩解率。24例病患於放射治療前，接受鼻咽腫瘤重切片，有13名（54.2%）病理報告無存活癌細胞。後續的強度調控放療也進行順利，總治療天數介於45-53天（中位數49天）。經中位追蹤21個月後，有四例發生遠處轉移，二年總存活率、原發及頸部無復發存活率、遠處轉移無復發存活率分別為100%、100%、和80%。結論：誘導化療合併爾必得舒標靶治療，隨後強度調控放療，對晚期鼻咽癌是一種高度有效且低毒性的治療方案。

並列關鍵字

鼻咽癌 ； 誘導化療 ； 爾必得舒 ； 放射治療