Recent Advances in Radiation Therapy for Head and Neck Cancer

Phase I study of anti--epidermal growth factor receptor antibody cetuximab in combination with radiation therapy in patients with advanced head and neck cancer

PURPOSE

To evaluate the safety, pharmacokinetics, and efficacy of a chimeric anti-epidermal growth factor receptor monoclonal antibody, cetuximab, in combination with radiation therapy (RT) in patients with advanced squamous cell carcinoma of the head and neck.

PATIENTS AND METHODS

We treated 16 patients in five successive treatment schedules. A standard dose escalation procedure was used; three patients entered onto the study at each dose level of cetuximab received conventional RT (70 Gy, 2 Gy/d), and the final three patients received hyperfractionated RT (76.8 Gy, 1.2 Gy bid). Cetuximab was delivered as a loading dose of 100 to 500 mg/m(2), followed by weekly infusions of 100 to 250 mg/m(2) for 7 to 8 weeks. Circulating levels of cetuximab during therapy were determined using a biomolecular interaction analysis core instrument. Human antichimeric antibody response was evaluated with a double-antigen radiometric assay. The recommended phase II/III dose was defined as the optimal cetuximab dose level based on the pharmacologic parameters and adverse events.

RESULTS

The most commonly reported adverse events were fever, asthenia, transaminase elevation, nausea, and skin toxicities (grade 1 to 2 in most patients). Skin toxicity outside of the RT field was not strictly dose-dependent; however, grade 2 or higher events were observed in patients treated with higher dose regimens. There was one grade 4 allergic reaction. Most acute adverse effects were associated with RT (xerostomia, mucositis, and local skin toxicity). No antibodies against cetuximab were detected. All patients achieved an objective response (13 complete and two partial remissions).

CONCLUSION

Cetuximab can be safely administered with RT. The recommended dose for phase II/III studies is a loading dose of 400 to 500 mg/m(2) and a maintenance weekly dose of 250 mg/m(2).

Intraoperative radiation therapy and Mohs micrographic surgery on an outpatient basis

BACKGROUND

Intraoperative radiation therapy (IORT) is used to deliver therapeutic doses of radiation to a surgically exposed tumor or tumor bed while minimizing the radiation dose to adjacent normal tissue. It is traditionally given with the patient under general anesthesia.

OBJECTIVE

To report a case of a recurrent squamous cell carcinoma treated with Mohs micrographic surgery and IORT on an outpatient basis.

METHODS

Mohs surgery was used to clear the tumor in all fields except for the area of the spinal accessory nerve, which was preserved. IORT was then delivered to the area of nerve with possible residual tumor.

RESULTS

The patient remains clinically tumor free 42 months posttreatment. There were no complications.

CONCLUSION

Intraoperative radiation therapy can be effectively used in the outpatient setting as an adjunctive therapy after Mohs micrographic surgery.