抗EGFR单抗治疗局部晚期头颈部鳞状细胞癌临床共识（2023年版）

doi:10.3760/cma.j.cn371439-20221021-00001

摘要/Abstract

关键词: 头颈部肿瘤, 放射疗法, 西妥昔单抗, 抗表皮生长因子受体抗体

许婷婷, 胡超苏, 李宝生. 抗EGFR单抗治疗局部晚期头颈部鳞状细胞癌临床共识（2023年版）[J]. 国际肿瘤学杂志, 2023, 50(1): 1-11.

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基于欧洲专家共识的放疗联合西妥昔单抗相关放射性皮炎的分级管理建议[73]"

分级	评判标准	基于分级的处理意见
1级	轻微红或干性脱皮	每周随访1次
2级	中度红斑和（或）干性脱皮；斑片状湿性脱皮，或局限于皮肤皱襞的非出血性结痂	每周随访2次 ①干性脱皮无结痂：短期（1~2周）使用糖皮质激素乳膏，怀疑二重感染的使用抗生素；②皮肤皱襞湿性脱皮：每天使用糖皮质激素乳膏（1~2周）减轻炎症反应，出现任何双重感染迹象时，局部使用针对金黄色葡萄球菌的抗生素。如二重感染加重，考虑全身使用抗生素，软锌制剂可用于皮肤皱襞，但应在放疗前将其去除以避免辐射剂量学问题，也可以使用伊红；③皮肤皱襞的非出血性结痂：同②的处理，此外，凝胶可用于结痂处
3级	湿性脱皮或出血性结痂；皮肤皱襞以外的非出血性结痂，但大部分局限于皮肤皱襞；轻微擦伤引起的出血；需要口服抗生素的二重感染	评估每天随访的必要性，密切监测局部或全身感染，如发生在<50 Gy，考虑短暂中断治疗 ①无结痂的湿性脱皮：外用抗菌剂，短期（1~2周）使用糖皮质激素乳膏，怀疑二重感染的使用抗生素，口服抗生素无效的考虑改静脉使用，软锌制剂可用于皮肤皱襞，但应在放疗前将其去除以避免辐射剂量学问题，也可以使用伊红；②有结痂的湿性脱皮：外用抗菌剂，怀疑二重感染的使用抗生素，口服抗生素无效的考虑改静脉使用，凝胶可用于结痂处，避免皮肤外伤以防止重复感染，如果使用水胶体敷料，在进行放疗剂量测定时应考虑敷料的厚度。放疗结束后可使用水纤维敷料
4级	危及生命；广泛的出血性结痂或溃疡（面积>50%）；受累部位大量自发性出血（>40%受累部位）；全真皮层皮肤坏死或溃疡或任何大小的溃疡，伴有广泛组织、肌肉、骨骼或支撑结构的坏死，伴有或不伴有全层皮肤受损；有皮肤移植指征；需要静脉使用抗生素的多重感染性溃疡	同时中断放疗和西妥昔单抗，西妥昔单抗需中断至皮炎恢复至2级或以下；严重二重感染口服抗生素无效的考虑改静脉使用；住院治疗

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患者因素	不宜使用标准剂量顺铂治疗	需谨慎顺铂治疗
年龄（岁）	N/A	>70
ECOG PS评分	≥2	≥1
营养不良（分）	N/A	PG-SGA评分≥3
合并症
肾功能不全	Ccr<50 ml/min	Ccr：50~60 ml/min
神经系统疾病	≥2级	1级
既往听力丧失/耳鸣	≥2级	1级
心功能不全	NYHA心功能分级≥Ⅱ级	NYHA心功能分级Ⅰ级
HIV/AIDS	N/A	CD4⁺ T淋巴细胞计数<200个/μl
既往铂类药物治疗（包括诱导化疗）	N/A	顺铂累积剂量≥200 mg/m²

出现次数	剂量调整
第1次	暂停西妥昔单抗治疗≤21 d直到皮疹降至2级。如改善，可重新开始250 mg/m²西妥昔单抗治疗；如无改善，暂停治疗
第2次	暂停西妥昔单抗治疗≤21 d直到皮疹降至2级。如改善，调整剂量为200 mg/m²西妥昔单抗治疗；如无改善，暂停治疗
第3次	暂停西妥昔单抗治疗≤21 d直到皮疹降至2级。如改善，调整剂量为150 mg/m²西妥昔单抗治疗；如无改善，暂停治疗
第4次	永久性停用西妥昔单抗

抗EGFR单抗治疗局部晚期头颈部鳞状细胞癌临床共识（2023年版）

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