Dose intensified hypofractionated intensity-modulated radiotherapy with synchronous cetuximab for intermediate stage head and neck squamous cell carcinoma

Abstract

They received three dose level simultaneous integrated boost IMRT, 62.5 Gy in 25 daily fractions to planning target volume one over fi ve weeks with synchronous cetuximab. The primary endpoint was acute toxicity. Secondary endpoints included: late toxicity and quality of life; loco-regional control, cause-specifi c and overall survival.Results. Radiotherapy was completed by 26/27 patients; for one (4%) the fi nal fraction was omitted due to skin toxicity. All cycles of cetuximab were received by 23/27 patients. Grade 3 acute toxicities included: pain (81%), oral mucositis (78%) and dysphagia (41%). There were few grade 3 physician-recorded late toxicities, including: pain (11%), problems with teeth (8%) and weight loss (4%). At 12 months, only one (4%) patient required a feeding tube, inserted prior to treatment due to dysphagia. The maximal/peak rates of patient-reported late toxicities included: severe pain (11%), any dry mouth (89%) and swallowing dysfunction that required a soft/liquid diet (23%). At 12 months, all quality of life and most symptoms mean scores had resolved to baseline or were only a little worse; dry mouth, sticky saliva and dentition scores remained very much worse. At a median follow-up of 47 months, there were fi ve (18.5%) loco-regional recurrences and the overall cause-specifi c survival was 79% (95% CI 53 -92).Conclusions. This regimen is safe with acceptable acute toxicity, low rates of late toxicity and impact on quality of life at 12 months following treatment. Further evaluation is recommended.

Practice recommendations for risk-adapted head and neck cancer radiotherapy during the COVID-19 pandemic: An ASTRO-ESTRO consensus statement

“…For early larynx cancer (T1N0), 50 Gy/16 f was most commonly recommended, 8,9 and there are data for 55 Gy/20 f in T2N0 disease. 10,11 There is limited evidence to support the use of hypofractionated radical radiation therapy over 4 to 5 weeks for locoregionally advanced disease, but panelists suggested schedules, including 55 Gy/20 f, [12][13][14][15] 62.5-64 Gy/25 f, 16,17 and 54 Gy/18 f. 18,19 Most would not use concomitant chemotherapy in this setting, and there was agreement to restrict concomitant chemotherapy to schedules of 2.4 Gy/f. Although there are data to support the use of concomitant platinum chemotherapy with higher doses per fraction, 13,14,16 panelists expressed reservations about the potential lack of benefit (eg, no apparent local control or overall survival advantage from the combination of chemotherapy with accelerated radiation therapy) 20,21 and the risk of increased acute and late toxicities.…”

Intra-tumor AvidinOX allows efficacy of low dose systemic biotinylated Cetuximab in a model of head and neck cancer

“…The anti-EGFR monoclonal antibody Cetuximab is approved in Europe and US for use in combination with chemo/radiation in patients with locally advanced and as monotherapy for recurrent and metastatic HNSCC [ 14 – 17 ]. Unfortunately, modest anti-tumor efficacy, together with significant side effects and costs remain major obstacles to its clinical wide spreading [ 4 , 18 ].…”

Cetuximab for Squamous Cell Carcinoma of the Head and Neck

“…Loco regional control and survivals were similar between the treatment arms (11). Several retrospective studies have been conducted to compare concomitant chemoradiation versus bioradiotherapy (12)(13)(14)(15)(16)(17)(18)(19)(34)(35)(36). The results have been variable.…”