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Strahlentherapie und Onkologie
Erschienen in: Strahlentherapie und Onkologie 10/2013

01.10.2013 | Original article

Reirradiation plus EGFR inhibition in locally recurrent and unresectable head and neck cancer

Final results from a single institution

verfasst von: D. Milanović, M.D., B. Jeremić, M.D., Ph.D., A.L. Grosu, M.D., G. Rücker, Ph.D., M. Henke, M.D.

Erschienen in: Strahlentherapie und Onkologie | Ausgabe 10/2013

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Abstract

Purpose

For some patients with recurrent, unresectable, and previously irradiated head and neck squamous cell carcinoma (HNSCC), reirradiation (re-RT) may be a curative option. Chemotherapy with epidermal growth factor receptor (EGFR) inhibition is established as palliative management. This retrospective single-institutional study investigates feasibility, toxicity, and outcome of reirradiation (re-RT) combined with EGFR blockade for these patients.

Patients and methods

Between June 2008 and June 2012, 23 patients with inoperable and previously irradiated HNSCC were reirradiated. Concomitant EGFR blockade (cetuximab) was given initially at 400 mg/m2 two days prior to re-RT and weekly (250 mg/m2) thereafter. PET/CT imaging was fused with planning CT in 8 patients.

Results

One patient died of anaphylactic shock during the first cetuximab administration; two discontinued treatment on their own request. In all, 20 patients completed re-RT (50.4–66.6 Gy) and received cetuximab as prescribed. Grade 3 acute side effects were documented for dermatitis (35 %), dysphagia (30 %), acneiform rash (30 %), and mucositis (15 %). The 1-year overall survival rate was 34.8 %. Median overall and progression-free survival times were 9 and 4.3 months, respectively. A multivariable analysis using the Cox regression model showed significant positive impact of acneiform rash (hazard ratio [HR] 0.1531, 95 % confidence interval [CI] 0.0383–0.6111), while a period from first radiation to re-RT longer than 120 months negatively (HR 0.1633, 95 % CI 0.0305–0.8734) influenced patient survival.

Conclusion

re-RT with concurrent cetuximab was feasible. Compared to platinum-based chemotherapy with fluorouracil and cetuximab, this therapeutic approach did not demonstrate survival benefit. Prolonged intervals from first treatment to re-RT seem to be unfavorable.
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Metadaten
Titel
Reirradiation plus EGFR inhibition in locally recurrent and unresectable head and neck cancer
Final results from a single institution
verfasst von
D. Milanović, M.D.
B. Jeremić, M.D., Ph.D.
A.L. Grosu, M.D.
G. Rücker, Ph.D.
M. Henke, M.D.
Publikationsdatum
01.10.2013
Verlag
Springer Berlin Heidelberg
Erschienen in
Strahlentherapie und Onkologie / Ausgabe 10/2013
Print ISSN: 0179-7158
Elektronische ISSN: 1439-099X
DOI
https://doi.org/10.1007/s00066-013-0402-6

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