title: Development and management of severe cutaneous side effects in head-and-neck cancer patients during concurrent radiotherapy and cetuximab.
abstract: BACKGROUND
  The concurrent administration of cetuximab to radiotherapy has recently been shown to improve the clinical outcome of head-and-neck cancer (HNC) patients. An aggravation of the radiation-induced skin toxicity was not described. Here, however, two cases with severe skin toxicity during the combined treatment are reported.
  
  
  METHODS
  In a small group of five patients with locally advanced HNC treated with irradiation and concurrent cetuximab, two cases of unusually severe radiation dermatitis were observed. Both patients developed confluent moist desquamations confined to the irradiation field at a dose of 40 Gy (CTC [Common Toxicity Criteria] grade 3), which progressed into an ulcerative dermatitis (grade 4) at 58 Gy and 46 Gy, respectively. Histopathology showed a vacuolic degeneration of basal keratinocytes, subepidermal blister formation, and mixed perivascular and interstitial inflammatory infiltrates leading to a complete loss of the epidermis. These cutaneous side effects led to the discontinuation of radiotherapy. Topical corticosteroids and systemic antibiotic treatment resulted in wound healing, which allowed the continuation of radiotherapy.
  
  
  CONCLUSIONS
  These findings indicate that cetuximab may have the potential to enhance the severity of radiation dermatitis in HNC patients. A systematic monitoring of cutaneous side effects during radiotherapy plus cetuximab is advised in order to reliably estimate the frequency of severe (grade 3/4) radiation dermatitis.
authors.affiliation: Department of Radiation Oncology, University of Duesseldorf, Germany.
authors.forename: Edwin
authors.initials: E
authors.lastname: Bölke
authors.forename: Peter Arne
authors.initials: PA
authors.lastname: Gerber
authors.forename: Guido
authors.initials: G
authors.lastname: Lammering
authors.forename: Matthias
authors.initials: M
authors.lastname: Peiper
authors.forename: Anja
authors.initials: A
authors.lastname: Müller-Homey
authors.forename: Hildegard
authors.initials: H
authors.lastname: Pape
authors.forename: Christian
authors.initials: C
authors.lastname: Giro
authors.forename: Christiane
authors.initials: C
authors.lastname: Matuschek
authors.forename: Daniela
authors.initials: D
authors.lastname: Bruch-Gerharz
authors.forename: Thomas K
authors.initials: TK
authors.lastname: Hoffmann
authors.forename: Stephan
authors.initials: S
authors.lastname: Gripp
authors.forename: Bernhard
authors.initials: B
authors.lastname: Homey
authors.forename: Wilfried
authors.initials: W
authors.lastname: Budach
mesh_terms: D000911:Antibodies, Monoclonal / Q000009:adverse effects* / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use; D000068818:Cetuximab; D003131:Combined Modality Therapy / Q000009:adverse effects; D005260:Female; D006258:Head and Neck Neoplasms / Q000150:complications / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011855:Radiodermatitis / Q000209:etiology* / Q000517:prevention & control*; D020266:Radiotherapy, Conformal / Q000009:adverse effects*
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000970:Antineoplastic Agents; D000068818:Cetuximab