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IMRT Reirradiation with Concurrent Cetuximab Immunotherapy in Recurrent Head and Neck Cancer

IMRT-Re-Bestrahlung mit simultaner Cetuximab-Immuntherapie bei rezidivierten Kopf-Hals-Tumoren

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Abstract

Purpose:

In this retrospective investigation, the outcome and toxicity after reirradiation with concurrent cetuximab immunotherapy of recurrent head and neck cancer (HNC) in patients who had contraindications to platinum-based chemotherapy were analyzed.

Materials and Methods:

Ten patients with locally advanced recurrent HNC were retrospectively evaluated. In 9 cases, histology was squamous cell carcinoma, in one case adenoid cystic carcinoma. External beam radiotherapy was part of the initial treatment in all cases. Reirradiation was carried out using step-and-shoot intensity-modulated radiotherapy (IMRT) with a median dose of 50.4 Gy. Cetuximab was applied as loading dose (400 mg/m2) 1 week prior to reirradiation and then weekly concurrently with radiotherapy (250 mg/m2).

Results:

The median overall survival time after initiation of reirradiation was 7 months; the 1-year overall survival (OS) rate was 40%. Local failure was found in 3 patients, resulting in a 1-year local control (LC) rate of 61%. The 1-year locoregional control (LRC) rate was 44%, while the 1-year distant metastasis-free survival (DMFS) was 75%. Acute hematological toxicity was not observed in the group. Severe acute toxicity included one fatal infield arterial bleeding and one flap necrosis. Severe late toxicities were noted in 2 patients: fibrosis of the temporomandibular joint in 1 patient and stenosis of the cervical esophagus in another.

Conclusions:

IMRT reirradiation with concurrent cetuximab immunotherapy in recurrent HNC is feasible with acceptable acute toxicity. Further investigations are necessary to determine the clinical role of this therapy concept.

Zusammenfassung

Ziel:

In dieser Untersuchung analysierten wir Behandlungsergebnis und Toxizität nach kombinierter Re-Bestrahlung mit simultaner Cetuximab-Immuntherapie von rezidivierten HNO-Tumoren bei Patienten mit Kontraindikation gegen platinhaltige Chemotherapie.

Patientengut und Methode:

10 Patienten mit lokal fortgeschrittenen rezidivierten HNO-Tumoren wurden retrospektiv ausgewertet. In 9 Fällen lag histologisch ein Plattenepithelkarzinom, in einem Fall ein adenoidzystisches Karzinom vor. In jedem Fall war eine Strahlentherapie Teil des initialen Behandlungskonzeptes. Die Re-Bestrahlung wurde mittels Step-and-shoot-IMRT mit einer medianen Dosis von 50,4 Gy durchgeführt. Cetuximab wurde als „Loading Dose“ (400 mg/m2) eine Woche vor Re-Bestrahlung und danach wöchentlich simultan zur Bestrahlung (250 mg/m2) verabreicht.

Ergebnisse:

Das mediane Gesamtüberleben nach Re-Bestrahlung war 7 Monate; das 1-Jahres-Gesamtüberleben betrug 40%. Ein Lokalrezidiv trat bei 3 Patienten auf, was zu einer 1-Jahres-Lokalkontrolle von 61% führte. Die 1-Jahres-lokoregionäre Kontrolle betrug 44%. Das 1-Jahres-Metastasen-freie Überleben war 75% (siehe Abbildungen 1–4). Eine akute hämatologische Toxizität wurde in diesem Kollektiv nicht gesehen. Schwere Akuttoxizitäten waren eine fatale arterielle Blutung und eine Flap-Nekrose. Als schwere Spättoxizität trat eine Fibrose der Pterygiodmuskulatur bzw. des Kiefergelenks sowie eine zervikale Ösophagusstenose auf (vgl. Tabellen 2 u. 3).

Schlussfolgerungen:

Bei rezidivierten HNO-Tumoren ist eine IMRT-Re-Bestrahlung mit 50 Gy und simultaner Cetuximab- Immuntherapie mit einer akzeptablen Toxizität durchführbar. Es sind weitere Untersuchungen nötig, um den Stellenwert dieser Therapieform zu überprüfen.

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Authors and Affiliations

  1. Department of Radiation Oncology, University of Heidelberg, Heidelberg, Germany

    Felix Zwicker, Falk Roeder, Christian Thieke, Carmen Timke, Marc W. Münter, Peter E. Huber & Jürgen Debus

  2. Division of Radiation Oncology, DKFZ, Heidelberg, Germany

    Felix Zwicker, Falk Roeder, Christian Thieke, Carmen Timke & Peter E. Huber

  3. Klinische Kooperationseinheit für Radioonkologie, Deutsches Krebsforschungszentrum (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany

    Felix Zwicker

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  1. Felix Zwicker
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Correspondence to Felix Zwicker.

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Zwicker, F., Roeder, F., Thieke, C. et al. IMRT Reirradiation with Concurrent Cetuximab Immunotherapy in Recurrent Head and Neck Cancer. Strahlenther Onkol 187, 32–38 (2011). https://doi.org/10.1007/s00066-010-2149-7

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  • DOI: https://doi.org/10.1007/s00066-010-2149-7

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