The Clinical Research Of Intensity Modulated Radiotherapy(IMRT) Joint Chemotherapy Combined Molecular Target Therapy On Nasopharyngeal Carcinoma (NPC)

Objective: to make the foundation for radiation therapy and chemotherapycombined with targeted drugs in the clinical application of Squamous Cell CarcinomaHead and Neck (SCCHN) by verifying the recent curative effect and adverse reaction ofNPC treated with cetuximab combined with chemotherapy or radiotherapy.Methods:Between November2007and November2011, the RadiotherapyDepartment of The First Hospital affiliated Dalian Medical University of received andcured11patients with NPC. According to the pathological and histological diagnosis,there were low differentiated squamous carcinoma8cases and undifferentiatedcarcinomas3cases. Among them, there were6men and5women with an median ageof41(rang16-56). The KPS were all above70. According to Chinese NasopharyngealCarcinoma2008Staging Standard,1patient had stage II,4stage Ⅲ, and6stage IV.All of them received Cetuximab combined with IMRT. The radiation plan was made byVARIAN-Eclipse plan system, and the treatment plan was optimized by reversecalculation. The evaluation was made on the bases of DVH (dose volume histogram)on target volume and the dose distribution of endanger on organs. The intensity ofexternal irradiation was strengthened by the6MV-X ray in9radiation fields. For10of these patients, the prescribed dose engaged to primary tumor and metastasis of lymphnode was66-78Gy,5F/week, each division dose2.0-2.1Gy, and the prescribed doseengaged to prevention field was50-74Gy, each division dose1.8-2.0Gy;1patient withpleural transfer received palliative radiation therapy, with the prescribed dose42Gy tochest. Cetuximab was injected through intravenous drip once weekly with the initialdose400mg/m2, and the maintenance dose was250mg/m2for4-9weeks(the median time was6weeks). At the same time this patient accepted PF chemotherapyplan.Results: With a median followed-up of19months, after3months short-termtreatment, CR was achieved to36.37%(4/11), PR was achieved to63.64%(7/11) witheffiency100%. Local-regional rate and survival time:1patient in11relapsed oncervical lymph nodes6months after the treatment. The local-regional rate was90.91％（10/11）.1patient appeared hepatic metastases11months after treatment and died ofhepatic metastases.1patient with Pleural metastasis (IVb period) died of the pleural andbone multiple distant metastases33months after Erbitux with chemotherapy andchest radiotherapy. The median survival time of the group was21months. Radiotherapyside effects: The most common adverse events of chemo and radiation were oral cavitymucous membrane oropharyngeal acute injury and bone marrow inhibitions. Tonguemucositis and stomatitis total incidence was54.56%(6/11), of which, the incidence ofIII degree was27.27%（3/11）, the incidence of III degree bone marrow inhibitions was45.45%（5/11）. The incidence of III degrees abnormal of glutamic-pyruvictransaminase was36.36%（4/11）. No allergic reaction cases. The incidence of skin acnerash were respectively I degree72.73%(8/11), II degrees18.19%(2/11), and IIIdegree9.09%(1/11).3patients with Treatment failure had I degree of skin acne rash2weeks after the the medicine.Conlusions:(1)The recent curative effect of IMRT joint Cetuximab Chemotherapy on NPC isdistinct, and the efficiency and local-regional rate are satisfactory.(2)Cetuximab combined with radiation or chemotherapy in treatment of NPC didnot increase the local skin rash radiation adverse events owing to targeted drugs, but theadverse event on tongue mucous membrane and oral mucosa had increased.(3)The IMRT joint Cetuximab Chemotherapy on pars nasalis pharyngis may alsolead to systemic adverse reaction, but normally the patient can tolerate it and no seriousadverse events.(4)Due to the small number of cases in this study, application time of cetuximabnot the very same, so it might have certain influence to the results. The results such aslong-term adverse reaction and survival rates remain to be studied further.