Efficacy and Safety of Combined Radiotherapy with EGFR Inhibitors and Chemotherapy for Laryngeal Organ Preservation in Patients with Locally Advanced Hypopharyngeal Carcinomas
Xinxin Zhang, Jailing Wang, Wenming Wu, Mingbo Liu, Feifang Zhao, Lei Du, Deliang Huang, Shiming Yang and Lin Ma
Affiliation: Department of Otolaryngology Head and Neck Surgery, PLA General Hospital, 28 Fuxing Road, Beijing, China.
Keywords: EGFR inhibitor, helical tomotherapy, intensity-modulated radiotherapy, laryngeal organ preservation, locally
advanced hypopharyngeal carcinoma, non-surgical combined modality.
Background: The present study was designed to evaluate the efficacy and safety of a combination of helical
tomotherapy (HT) or intensity-modulated radiotherapy (IMRT) and EGFR (epidermal growth factor receptor) inhibitor
(Cetuximab or Nimotuzumab) with or without chemotherapy in patients with locally advanced hypopharyngeal
Patients and Methods: The retrospective study included forty-six patients (12 stage III and 34 stage IV) with locally
advanced hypopharyngeal cancer. Among them, 20 were treated with induction chemotherapy with docetaxel and
cisplatin (TP) followed by concurrent chemoradiotherapy with cisplatin and EGFR inhibitor, 13 received concurrent
chemoradiotherapy with cisplatin and EGFR inhibitor, and 13 were treated with concurrent radiotherapy plus EGFR
inhibitor. HT and IMRT were performed in 33 and 13 patients, respectively. Side effects were evaluated with the
established CTCAE (Common Terminology Criteria for Adverse Events) 3.0 criteria.
Results: The median follow-up time was 39.4 months (range 3-69 months). All patients completed the planned RT without
any treatment breaks. The 3-year local control survival, disease-free survival, overall survival, and laryngeal preservation
survival rates were 66.8%, 59.0%, 68.9%, and 86.7%, respectively. The most common grade 3 or higher side effect was
oropharyngeal mucositis. One patient required dilatation of a pharyngeal stricture 18 months after treatment. No patient
required percutaneous gastrostomy and tracheostomy tube.
Conclusion: The treatment with EGFR inhibitor in combination with non-surgical combined modality in patients with
hypopharyngeal carcinoma was well tolerated and resulted in encouraging laryngeal preservation survival rate. HT or
IMRT, EGFR inhibitor, and effective management of severe oropharyngeal mucositis contributed to the positive
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