Adjuvant stereotactic body radiotherapy ± cetuximab following salvage surgery in previously irradiated head and neck cancer

• Published in: The Laryngoscope 2014-07, Vol.124 (7), p.1579-1584
• Main Authors: Vargo, John A., Kubicek, Gregory J., Ferris, Robert L., Duvvuri, Umamaheswar, Johnson, Jonas T., Ohr, James, Clump, David A., Burton, Steven, Heron, Dwight E.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Antibodies, Monoclonal, Humanized - therapeutic use; Antineoplastic Agents - therapeutic use; Carcinoma, Squamous Cell - diagnosis; Carcinoma, Squamous Cell - mortality; Carcinoma, Squamous Cell - therapy; Cetuximab; Chemotherapy; Combined Modality Therapy; Disease-Free Survival; ErbB Receptors; Female; Follow-Up Studies; Head & neck cancer; Head and Neck Neoplasms - diagnosis; Head and Neck Neoplasms - mortality; Head and Neck Neoplasms - therapy; Humans; Incidence; Male; Middle Aged; Neoplasm Recurrence, Local - epidemiology; Neoplasm Recurrence, Local - therapy; Neoplasm Staging; Quality of Life; Radiation therapy; Radiosurgery - methods; Radiotherapy Dosage; Radiotherapy, Adjuvant - methods; recurrent head and neck cancer; reirradiation; Retrospective Studies; Salvage; salvage surgery; Salvage Therapy - methods; Squamous Cell Carcinoma of Head and Neck; Stereotactic body radiation therapy; Surgery; Survival Rate - trends; United States - epidemiology
• ISSN: 0023-852X; 1531-4995
• DOI: 10.1002/lary.24441

Objectives/Hypothesis Locoregional recurrence remains the primary failure pattern following salvage surgery for previously irradiated head and neck cancer; randomized trials have suggested a complimentary role for adjuvant chemotherapy and conventional reirradiation at the expense of significant increases in toxicity. We aimed to identify if stereotactic body radiotherapy (SBRT) ± cetuximab improves tumor control while reducing treatment‐related toxicity following salvage surgery. Study Design Retrospective review (2005–2011) of 28 patients with high‐risk features (positive surgical margins or extranodal extension) following macroscopic complete (R0/R1) salvage surgery treated with adjuvant SBRT ± cetuximab. Methods SBRT consisted of 40 to 44 Gy in five fractions over 1 to 2 weeks with concurrent cetuximab (n = 7) administered at 400 mg/m2 day −7 + 250 mg/m2 days 0 and +8. Toxicity was physician recorded, and University of Washington Quality of Life Revised surveys were prospectively collected. Results All patients received prior radiotherapy (median, 70 Gy; range, 54–99 Gy) with a median reirradiation interval of 25 months (range, 6–156 months). At a median follow‐up of 14 months (range, 2–69 months), the 1‐year locoregional control, distant control, disease‐free survival, and overall survival were 51%, 90%, 49%, and 64%, respectively. Rates of acute and late severe (≥grade 3) toxicity were low at 0% and 8%, respectively. At a median follow‐up survey time of 6 months, 56% of patients reported improved/stable overall quality‐of‐life scores. Conclusions Adjuvant SBRT ± cetuximab following salvage surgery is well tolerated with acceptable oncologic outcomes and little toxicity. Future prospective trials should evaluate adjuvant SBRT ± cetuximab versus a wait‐and‐see approach for recurrent head and neck cancers with high‐risk features following salvage surgery. Level of Evidence 4 Laryngoscope, 124:1579–1584, 2014