Stereotactic body radiotherapy plus cetuximab for previously irradiated un-resectable head and neck cancer

Tai-Lin Huang; Hui-Ching Chuang; Ming-Hsien Tsai; Chih-Yen Chien; Yan-Ye Su; Yu-Tsai Lin; Chao-Hui Yang; Chi-Chih Lai; Shau-Hsuan Li; Fu-Min Fang

doi:10.1016/j.bj.2021.10.013

Stereotactic body radiotherapy plus cetuximab for previously irradiated un-resectable head and neck cancer

Biomed J. 2022 Oct;45(5):838-846. doi: 10.1016/j.bj.2021.10.013. Epub 2021 Nov 5.

Authors

Affiliations

¹ Department of Hematology-Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
² Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan.
³ Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
⁴ Department of Hematology-Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan.
⁵ Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan. Electronic address: fang2569@cgmh.org.tw.

Abstract

Background: The aim of the study was to explore the treatment outcomes and prognostic factors for patients with previously irradiated but unresectable recurrent head and neck squamous cell carcinoma (rHNSCC) treated by stereotactic body radiotherapy (SBRT) plus cetuximab at a single institute in Taiwan.

Methods: From February 2016 to March 2019, 74 patients with previously irradiated but unresectable rHNSCC were treated with SBRT plus cetuximab. All patients received irradiation to the gross tumor and/or nodal area with 40-50 Gy in five fractions, with each fraction interval ≥2 days over a 2-week period by using the CyberKnife M6 machine. An¹⁸F-fluorodeoxyglucose positron emission tomography-computed tomography (PET-CT) scan was performed before treatment for treatment target delineation (n = 74) and 2 months later for response evaluation (n = 60). The median follow-up time was 9 months (range 1-36 months).

Results: The treatment response rate was complete response: 25.0%, partial response: 41.7%, stable disease: 11.7%, and progressive disease: 21.7% based on the criteria of the Response Evaluation Criteria in Solid Tumors (n = 72) and complete metabolic response: 21.7%, partial metabolic response: 51.7%, stable metabolic disease: 13.3%, and progressive metabolic disease: 13.3% based on PET-CT (n = 60), respectively. The 1-/2-year overall survival (OS) and progression-free survival (PFS) rates were 42.8%/22.0% and 40.5%/19.0%, respectively. In the logistic regression model, a re-irradiation interval >12 months was observed to be the only significant prognostic factor for a favorable treatment response. In the Cox proportional hazards model, a re-irradiation interval >12 months and gross tumor volume (GTV) ≦ 50 ml were favorable prognostic factors of OS and PFS.

Conclusion: SBRT plus cetuximab provides a promising salvage strategy for those patients with previously irradiated but unresectable rHNSCC, especially those with a re-irradiation interval >12 months or GTV ≦ 50 ml.

Keywords: Cetuximab; Gross tumor volume; Head and neck squamous cell carcinoma; PET-CT; Re-irradiation; Stereotactic body radiotherapy.

MeSH terms

Carcinoma*
Cetuximab / therapeutic use
Head and Neck Neoplasms* / drug therapy
Head and Neck Neoplasms* / etiology
Head and Neck Neoplasms* / radiotherapy
Humans
Metabolic Diseases*
Neoplasm Recurrence, Local / surgery
Positron Emission Tomography Computed Tomography
Radiosurgery* / adverse effects
Radiosurgery* / methods
Squamous Cell Carcinoma of Head and Neck / radiotherapy

Substances

Cetuximab