摘 要 目的: EGFR与鼻咽癌关系密切，西妥昔单抗是一种特异性阻断EGFR的单克隆抗体。观察调强适型放射治疗联合西妥昔单抗(cetuximab)及顺铂（cisplatin ,又称DDP）方案治疗晚期鼻咽癌的有效性和安全性。方法: 2007年7月至2007年12月共8例入组，其中初治鼻咽癌7例，复发鼻咽癌1例，所有病例均为Ⅲ、Ⅳ期；所有患者都签署知情同意书，研究报伦理委员会批准。治疗方法包括调强放疗、顺铂、西妥昔单抗（400 mg/m2，放射治疗前1周；250 mg/m2，每周1次，放疗期间维持）。结果: 8例均完成调强放疗。8例完成西妥昔单抗治疗4～8疗程，平均6个疗程；3例因肝功异常未行同期化疗，3例完成DDP 30 mg/m2化疗4～7疗程，1例完成DDP 100 mg/m2化疗2疗程，1例完成DDP 100 mg/m2化疗1疗程。8例均出现皮肤痤疮样皮疹，主要急性毒性反应为黏膜炎和骨髓抑制；黏膜炎8例；白细胞下降3例；3个月后所有反应为0～1级。8例均达完全缓解(complete remission,CR)，1例患者综合治疗后3个月出现肋骨转移。结论: 调强放疗联合西妥昔单抗及顺铂方案治疗晚期鼻咽癌的不良反应主要为口咽黏膜炎和疼痛较重，有2例不可耐受，建议降低西妥昔单抗的剂量。近期疗效令人满意，远期疗效尚需观察。

Abstract Objective: Epidermal growth factor receptor（EGFR）is closesly related to nasopharyngeal carcinoma (NPC). Cetuximab is a monoclonal antibody that specifically blocks the EGFR. We aimed to explore the efficacy and toxicity of intensity modulated radiation therapy (IMRT) combined with cetuximab and cisplatin in the treatment of patients with NPC. Methods: From July 2007 to December 2007, 8 patients, including 7 with primary NPC patients and one with reoccurred NPC were included in this study; all patients were at stage Ⅲ or Ⅳ. Treatment included IMRT, cisplatin and cetuximab (400 mg/m2 one week prior to radiotherapy, followed by 250 mg/m2 once a week during radiotherapy). Results: All eight patients completed the planned IMRT. The median treatment cycle of cetuximab was 6 (ranging 4 to 8 cycles). Three patients received no chemotherapy due to hepatic dysfunction; 3 were treated with 4-7 cycles of cisplatin (30 mg/ m2, once a week); one was treated with two cycles of cisplatin (100 mg/m2); and another was treated with one cycle of cisplatin (100 mg/m2). All eight patients were presented with acnelike rash. The acute side effects were mucositis and neutropenia. Mucositis occurred in all the 8 patients; neutropenia occurred in 3 patients. After combined therapy, all 8 patients achieved complete remission (CR). During a followup of 4-10 months, one patient was diagnosed as having leb metastasis. Conclusion: IMRT in combination with cetuximab and chemotherapy in treatment of acute mucositis in patients with advanced nasopharyngeal carcinoma is too much for the patients; two of patients in the present group are intolerable. We suggest dose decrease of cetuximab. The short term efficacy is encouraging, and the longterm outcomes need to be further investigated.