鼻咽癌IMRT同期EGFR单抗和同期化疗与单纯IMRT的回顾对照研究

目的 回顾性对比IMRT同期EGFR单抗、同期化疗和单纯IMRT治疗鼻咽癌的疗效及不良反应。方法 将2008—2012年间收治的68例接受IMRT同期EGFR单抗的Ⅱ—Ⅳ_b期初治鼻咽癌患者纳入BRT组,应用SAS软件进行1∶2配对形成单纯IMRT (IMRT)组136例及同期放化疗(CCRT)组136例,共340例。Kaplan-Meier法计算生存率并Logrank检验,Cox模型分析预后因素。结果 BRT、IMRT、CCRT组3年样本数分别为14、69、47例。全组3年OS、DFS、LRC、DMFS分别为91.2%、80.2%、93.1%、87.2%。BRT、IMRT、CCRT组的3年OS分别为91.9%、 92.1%、89.9%(P=0.379),3年DFS分别为82.1%、77.9%、81.6%(P=0.594),3年LRCR分别为98.2%、90.6%、93.0%(P=0.249),3年DMFS分别为85.2%、85.2%、90.3%(P=0.383)。多因素分析提示T分期及同期EGFR单抗是LRC的影响因素(P=0.034、0.032)。结论 鼻咽癌单纯IMRT即可达较好疗效。三组之间整体疗效相近,但BRT组有提高LRC的趋势。

Clinical effects of IMRT combined with EGFR monoclonal antibody,concurrent chemoradiotherapy,and IMRT alone in nasopharyngeal carcinoma patients:a retrospective case-control study

Objective To compare the treatment outcomes and toxicities in nasopharyngeal carcinoma patients who receive intensity-modulated radiotherapy (IMRT) combined with epidermal growth factor receptor (EGFR) monoclonal antibody, IMRT with concurrent chemotherapy, and IMRT alone. Methds Sixty-eight previously untreated patients with stage Ⅱ-IV_b nasopharyngeal carcinoma (NPC) who received IMRT combined with cetuximab or nimotuzumab from January 2008 to September 2012 were included in BRT group;the BRT group was matched with 136 patients treated with concurrent chemoradiotherapy (CCRT) and 136 patients treated with IMRT alone at a ratio of 1∶2 using SAS software. The Kaplan-Meier method was used for calculating survival rates, and the log-rank test was used for survival difference analysis. Prognostic factors were analyzed by the Cox model. Results The sample sizes of the BRT group, IMRT group, and CCRT group were 14,69,47, respectively. The 3-year overall survival (OS), disease-free survival (DFS), locoregional control (LRC), and distant metastasis-free survival (DMFS) of all patients were 91.2%, 80.2%, 93.1%, and 87.2%, respectively. The 3-year OS rates of BRT group, IMRT group, and CCRT group were 91.9%, 92.1%, and 89.9%, respectively (P=0.379);the 3-year DFS rates of BRT group, IMRT group, and CCRT group were 82.1%, 77.9%, and 81.6%, respectively (P=0.594);the 3-year LRC rates of BRT group, IMRT group, and CCRT group were 98.2%, 90.6%, and 93.0%, respectively (P=0.249);the 3-year DMFS rates of BRT group, IMRT group, and CCRT group were 85.2%, 85.2%, and 90.3%, respectively (P=0.383). Multivariate prognostic analysis showed that T stage and concurrent use of EGFR monoclonal antibody were influential factors for LRC (P=0.034 and 0.032). Conclusions IMRT alone yields a good treatment outcome in NPC patients. Although there were no significant differences in OS between the three groups, the BRT group showed an increasing trend in LRC.