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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

Purpose:

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).

Results:

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.

Conclusion:

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

Ziel:

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.

Ergebnisse:

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.

Schlussfolgerung:

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.

Schlüsselwörter:

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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