Adjuvant Stereotactic Body Radiotherapy +/- Cetuximab Following Salvage Surgery in Previously Irradiated Head and Neck Cancer

作者：Vargo John A; Kubicek Gregory J; Ferris Robert L; Duvvuri Umamaheswar; Johnson Jonas T; Ohr James; Clump David A; Burton Steven; Heron Dwight E^*

来源：Laryngoscope, 2014, 124(7): 1579-1584.

DOI：10.1002/lary.24441

• Stereotactic body radiation therapy
• recurrent head and neck cancer
• reirradiation
• salvage surgery
• cetuximab

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/m(2) day -7+250 mg/m(2) 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.

• 出版日期2014-7