局部中晚期头颈部鳞状细胞癌老年患者非手术综合治疗的有效性和安全性分析  

Effects and safety of non-surgical comprehensive treatment for elderly patients with locally advanced head and neck squamous cell carcinoma

作　　者：游玮 刘坤 陈南翔[1] 魏健 张欣欣[1] YOU Wei;LIU Kun;CHEN Nanxiang;WEI Jian;ZHANG Xinxin(Department of Otolaryngology,Head and Neck Surgery,Chinese PLA General Hospital,Beijing 100853,China)

机构地区：[1]解放军总医院耳鼻咽喉头颈外科医学部,北京100853

出　　处：《解放军医学院学报》2023年第10期1089-1097,共9页Academic Journal of Chinese PLA Medical School

摘　　要：背景头颈部鳞状细胞癌(head and neck squamous cell carcinoma,HNSCC)治疗中应用同步放化疗或同步表皮生长因子受体(epidermal growth factor receptor,EGFR)分子靶向治疗,可以显著提高HNSCC患者的生存率。但老龄患者与具有相同疾病状态的年轻患者相比,可能会接受相对保守和次优的治疗。老年患者局部晚期头颈鳞癌的治疗选择是目前临床面临的难题。目的探讨老年人头颈部鳞状细胞癌非手术治疗的有效性和安全性。方法回顾性分析2012年2月-2021年6月解放军总医院第一医学中心耳鼻喉头颈外科收治的老年头颈鳞状细胞癌患者的病例资料。生存分析采用Kaplan-Merier方法和Log-rank检验。放化疗不良反应采用不良事件标准(common terminology criteria for adverse events,CTCAE)第5版评估。结果36例患者年龄为75~87(78.0±3.0)岁,临床分期Ⅲ~Ⅳ期,所有患者行诱导化疗或加EGFR分子靶向治疗后同步放疗联合EGFR分子靶向治疗或加化疗。其中24例患者在诱导化疗阶段应用了EGFR分子靶向治疗,21例患者在同步放疗联合EGFR分子靶向治疗阶段应用了化疗药物,15例患者行放疗联合EGFR分子靶向治疗。放疗采用调强放疗,总剂量为66~70 Gy。全部患者完成了既定的化疗和EGFR分子靶向治疗计划,35例(97.2%,35/36)完成既定的放疗计划。综合治疗1个月后影像学评估,均达到完全缓解,总生存率(overall survival,OS)率1年为84.8%,2年为49.2%,3年为41.0%;无进展生存(progression-free survival,PFS)率1年为85.8%,2年为46.1%,3年为34.1%;中位生存时间20个月。Kaplan-Meier生存分析表明:单纯放疗+EGFR分子靶向治疗组的中位无进展生存期为13个月,低于同步放化疗+EGFR分子靶向组的36个月;单纯放疗+EGFR分子靶向治疗组的2年总生存率(38.8%vs 67.1%)和无进展生存率(11.8%vs 67.1%)均低于同步放化疗+EGFR分子靶向组;两组OS和PFS的差异有统计学意义(P<0.05)。综合治疗过程中,均Background In the treatment of head and neck squamous cell carcinoma(HNSCC),the survival rate of patients with HNSCC can be significantly improved by using simultaneous chemoraotherapy or simultaneous molecular targeting of EGFR.But older patients may receive less aggressive and suboptimal treatment than younger patients with the same disease status.The treatment choice of elderly patients with advanced head and neck squamous cell carcinoma is a difficult problem faced by current clinical treatment.Objective To investigate the efficacy and safety of comprehensive treatments in elderly patients with head and neck squamous cell carcinoma(HNSCC).Methods Clinical data about patients who were admitted to the Department of Otolaryngology,Head and Neck Surgery,the First Medical Center of Chinese PLA General Hospital from February 2012 to June 2021,were analyzed retrospectively.The overall survival(OS)and progression-free survival(PFS)were determined by Kaplan-Merier method,and log-rank test was adopted to compare the differences between subgroups.Adverse events were evaluated with the established common terminology criteria for adverse events(CTCAE)version 5.0 criteria.Results Totally 36 patients were included.The median age was(78.0±3.0)years old(ranged from 75 to 87 years old),and their mainly clinical stage wasⅢ-Ⅳ.All the patients received induction chemotherapy+/-EGFR molecular targeted therapy followed by concurrent radiotherapy combined with EGFR molecular targeted therapy+/-chemotherapy.Among them,24 patients received EGFR molecular targeted therapy at the ICT stage,21 patients received chemotherapeutic drugs at concurrent radiotherapy combined with EGFR molecular targeted therapy,and 15 patients received radiotherapy combined with EGFR molecular targeted therapy.Intensity modulated radiotherapy was used for radiotherapy,the total dose of radiotherapy was 66-70 Gy.All patients completed the established chemotherapy and EGFR molecular targeted therapy schedule,and 35 patients(97.2%)completed the established r

关 键 词：头颈部鳞状细胞癌 老年人 安全性 疗效 肿瘤综合治疗 

分 类 号：R739.91[医药卫生—肿瘤]