Strahlentherapie und Onkologie

, Volume 189, Issue 10, pp 842–848

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

Final results from a single institution
  • D. Milanović
  • B. Jeremić
  • A.L. Grosu
  • G. Rücker
  • M. Henke
Original article

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.

Keywords

Reirradiation Cetuximab Head and neck neoplasms Epidermal growth factor receptor Chemotherapy 

Rebestrahlung und EGFR-Inhibition beim lokal rezidivierten, nichtresektablen Kopf-Hals-Karzinom

Abschließende Ergebnisse einer monozentrischen Studie

Zusammenfassung

Hintergrund

Eine erneute Bestrahlung (Re-RT) kann für Patienten mit rezidiviertem, nichtresektablem Kopf-, Hals-Karzinom (HNSCC) eine kurative Option darstellen, während Chemotherapie und Inhibition des epidermalen Wachstumsfaktorrezeptors (EGFR) nur eine palliative Rolle spielen. Diese retrospektive und monozentrische Studie untersucht bei diesen Patienten die Durchführbarkeit, Toxizität und Effektivität einer Re-RT mit simultaner EGFR-Inhibition mit Cetuximab.

Methoden

Von Juni 2008 bis Juni 2012 wurden 23 nichtselektierte Patienten mit rezidiviertem, histologisch gesichertem und nichtresektablem, vorbestrahltem HNSCC erneut bestrahlt. Sie erhielten zusätzlich 2 Tage vor der Re-RT 400 mg/m2 Cetuximab (EGFR-Blockade), gefolgt von 6 wöchentlichen Gaben à 250 mg/m2. Bei 8 Patienten erfolgte die Bestrahlungsplanung aufgrund der PET/CT-Bildgebung.

Ergebnisse

Ein Patient verstarb an einem anaphylaktischen Schock nach der ersten Cetuximabgabe, zwei weitere brachen die Behandlung auf eigenen Wunsch ab. Insgesamt 20 Patienten wurden mit 59,4 Gy (50,4–66,6 Gy) und Cetuximab behandelt. Akute Grad-3-Nebenwirkungen wurden für Dermatitis (35 %), Dysphagie (30 %), akneiformes Exanthem (30 %) und Mukositis (15 %) beobachtet. Die 1-Jahres-Überlebensrate lag bei 34,8 %. Medianes und progressionsfreies Überleben betrugen 9 und 4,3 Monate. In der multivariaten Cox-Analyse waren akneiformes Exanthem positiv (Hazard Ratio [HR] 0,1531; 95 %-Konfidenzintervall [CI] 0,0383–0,6111) und mehr als 120 Monate zwischen erster und Re-RT negativ (HR 0,1633; 95 % CI 0,0305–0,8734) zum Überleben korreliert.

Schlussfolgerung

Eine Re-RT mit simultaner Cetuximabgabe ist bei Patienten mit rezidiviertem HNSCC durchführbar. Tumorkontrolle und Überleben entsprechen allerdings Berichten nach alleiniger Cisplatin-, 5-Fluorouracil- und Cetuximab-Gabe. Ein prolongiertes Intervall zwischen erster Bestrahlung und Re-RT erscheint eher ungünstig.

Schlüsselwörter

Rebestrahlung Cetuximab Kopf-Hals-Karzinom Epidermaler Wachstumsfaktorrezeptor Chemotheapie 

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Copyright information

© Springer Heidelberg Berlin 2013

Authors and Affiliations

  • D. Milanović
    • 1
  • B. Jeremić
    • 2
  • A.L. Grosu
    • 1
  • G. Rücker
    • 3
  • M. Henke
    • 1
  1. 1.Department of Radiation OncologyUniversity Medical Center FreiburgFreiburgGermany
  2. 2.Division of Radiation OncologyUniversity of Stellenbosch Medical School and Tygerberg, HospitalCape TownRepublic of South Africa
  3. 3.Institute of Medical Biometry and Medical InformaticsUniversity Medical Center FreiburgFreiburgGermany

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