Strahlentherapie und Onkologie

, 185:775 | Cite as

Combined Cetuximab and Reirradiation for Locoregional Recurrent and Inoperable Squamous Cell Carcinoma of the Head and Neck

  • Panagiotis Balermpas
  • Markus Hambek
  • Oliver Seitz
  • Claus Rödel
  • Christian WeissEmail author
Current Discussion


To investigate the feasibility, toxicity, and efficacy of external-beam reirradiation (Re-RT) combined with cetuximab for patients with inoperable and recurrent squamous cell carcinoma of the head and neck (SCCHN).

Patients and Methods:

Seven patients with inoperable recurrence of SCCHN after adjuvant or definitive radiotherapy (RT) and simultaneous or sequential cisplatin-based chemotherapy for primary SCCHN were treated between August and December 2008 with Re-RT (1.8 Gy/fraction to 50.4 Gy) and cetuximab (400 mg/m2 initial dose in the 1st week, and then 250 mg/m2 once weekly). Recurrence had to be located at least ≥ 50% in the preirradiated field. Long term toxicity from previous treatment was recorded before Re-RT as a baseline value. Acute and late toxicity derived from the experimental regimen were recorded every week during RT, and then every 3 months. Efficacy was assessed with repeated imaging using response evaluation criteria in solid tumors (RECIST) and clinical examinations 8–12 weeks after end of the treatment and every 3 months thereafter (Tables 1 and 2).


Only mild localized mucositis occurred in all patients. Two patients developed a grade 3 acneiform rash related to cetuximab. After treatment one patient developed a grade 2 trismus, another showed grade 3 abacterial salivary gland inflammation with severe pain requiring opioid medication. Two patients achieved a complete response after 7 months, one remained stable, three progressed, and one died from pneumonia without having restaging magnetic resonance imaging.


A second course of RT combined with cetuximab in patients with inoperable, recurrent HNSCC proved to be feasible with mild or moderate toxicity and encouraging response to treatment.

Key Words:

Reirradiation Cetuximab Antibody Head-and-neck cancer Radiotherapy 

Cetuximab plus Rebestrahlung bei lokoregionär rezidiviertem und inoperablem Plattenepithelkarzinom der Kopf-Hals-Region


Erfassung der Durchführbarkeit, Nebenwirkungen und Effizienz einer perkutanen Rebestrahlung (Re-RT) zusammen mit Cetuximab bei Patienten mit inoperablen und rezidivierten Plattenepithelkarzinomen der Kopf-Hals-Region ((CCHN).

Patienten and Methodik:

Sieben Patienten mit inoperablen, rezidivierten SCCHN nach adjuvanter oder definitiver Radiotherapie (RT) und simultaner oder sequentieller cisplatinbasierter Chemotherapie wurden zwischen August und Dezember 2008 mit einer Re-RT (1,8 Gy bis 50,4 Gy) und Cetuximab (400 mg/m2 Anfangsdosis in der 1. Woche und danach 250 mg/m2 einmal wöchentlich) behandelt. Die Rezidivlokalisation musste zu mehr als 50% in der vorbestrahlten Region liegen. Vor Beginn der Re-RT wurden die Nebenwirkungen durch die vorangegangenen Therapien als Ausgangswerte erfasst. Die Akutnebenwirkungen und Spätfolgen durch die experimentelle Behandlung wurden wöchentlich während Re-RT, und dann alle 3 Monate erhoben. Das Therapieansprechen wurde mit wiederholter Bildgebung, anhand der RECIST-Kriterien („response evaluation criteria in solid tumors“) und klinischen Untersuchungen 8–12 Wochen nach Beendigung der Re-RT und danach alle 3 Monate erhoben.


Bei allen Patienten trat eine milde lokalisierte Mukositis auf. Zwei Patienten zeigten eine Grad-3-Akne auf Cetuximabgabe. Nach der Re-RT entwickelte ein Patient einen Trismus (Grad 2), ein anderer eine abakterielle Grad-3-Sialadenitis mit starken Schmerzen, die einer Opioidmedikation bedurften. Zwei Patienten erreichten 7 Monate nach Re-RT eine komplette Remission, einmal zeigt sich der Rezidivtumor stabil, drei waren progredient, und ein Patient verstarb an einer Pneumonie ohne erneute Bildgebung.


Für Patienten mit inoperablen, rezidivierten HNSCC erweist sich eine erneute RT zusammen mit Cetuximab mit nur geringen oder moderaten Nebenwirkungen und ermutigendem Therapieanspechen als durchführbar.


Rebestrahlung Cetuximab Antikörper Kopf-Hals-Karzinome Radiotherapie 


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Copyright information

© Urban & Vogel, Muenchen 2009

Authors and Affiliations

  • Panagiotis Balermpas
    • 1
  • Markus Hambek
    • 2
  • Oliver Seitz
    • 3
  • Claus Rödel
    • 1
  • Christian Weiss
    • 1
    • 4
    Email author
  1. 1.Department of Radiation Therapy and OncologyGoethe UniversityFrankfurt/MainGermany
  2. 2.Department of OtorhinolaryngologyGoethe UniversityFrankfurt/MainGermany
  3. 3.Department of Oral Maxillofacial and Plastic Facial SurgeryGoethe UniversityFrankfurt/MainGermany
  4. 4.Department of Radiation Therapy and OncologyGoethe University of Frankfurt/MainFrankfurtGermany

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