title: Salvage stereotactic reirradiation with or without cetuximab for locally recurrent head-and-neck cancer: a feasibility study.
abstract: OBJECTIVE
  Normal tissues tolerance limits the use of reirradiation for recurrent head-and-neck cancers (HNC). Stereotactic body radiotherapy (SBRT) could offer precise irradiation while sparing healthy tissues. Results of a feasibility study using SBRT with or without cetuximab are reported for reirradiation of recurrent primary HNC.
  
  
  METHODS
  Patients with inoperable recurrent, or new primary tumor, in a previously irradiated area were included. Reirradiation dose was 36 Gy in six fractions of 6 Gy to the 85% isodose line covering 95% of the planning target volume. Patients with squamous cell carcinoma received concomitant cetuximab.
  
  
  RESULTS
  Between June 2007 and January 2010, 40 patients were prospectively treated for 43 lesions. Median age was 60 and median tumor size was 29 mm. Fifteen patients received concomitant cetuximab and 1 received concomitant cisplatin. Median follow-up was 25.6 months with 34 patients evaluable for tumor response. Median overall survival was 13.6 months and response rate was 79.4% (15 complete and 12 partial responses). Grade 3 toxicity occurred in 4 patients.
  
  
  CONCLUSIONS
  These results suggest that short SBRT with or without cetuximab is an effective salvage treatment with good response rate in this poor prognosis population with previously irradiated HNC. Treatment is feasible and, with appropriate care to limiting critical structure, acute toxicities are acceptable. A prospective multicenter Phase II trial of SRT and concomitant cetuximab in recurrent HNC squamous cell carcinoma is ongoing.
authors.affiliation: Department of Academic Radiotherapy, Centre Oscar Lambret and University Lille II, Lille, France.
authors.forename: Bénédicte
authors.initials: B
authors.lastname: Comet
authors.forename: Andrew
authors.initials: A
authors.lastname: Kramar
authors.forename: Mathieu
authors.initials: M
authors.lastname: Faivre-Pierret
authors.forename: Sylvain
authors.initials: S
authors.lastname: Dewas
authors.forename: Bernard
authors.initials: B
authors.lastname: Coche-Dequeant
authors.forename: Marian
authors.initials: M
authors.lastname: Degardin
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Lefebvre
authors.forename: Thomas
authors.initials: T
authors.lastname: Lacornerie
authors.forename: Eric F
authors.initials: EF
authors.lastname: Lartigau
mesh_terms: D000328:Adult; D000368:Aged; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized; D000970:Antineoplastic Agents / Q000627:therapeutic use; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D000068818:Cetuximab; D002945:Cisplatin / Q000627:therapeutic use; D018572:Disease-Free Survival; D005240:Feasibility Studies; D005260:Female; D006258:Head and Neck Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D011446:Prospective Studies; D016634:Radiosurgery / Q000009:adverse effects / Q000379:methods*; D011879:Radiotherapy Dosage; D019233:Retreatment / Q000009:adverse effects / Q000379:methods; D016879:Salvage Therapy / Q000009:adverse effects / Q000379:methods*; D047368:Tumor Burden; D055815:Young Adult
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000970:Antineoplastic Agents; D000068818:Cetuximab; D002945:Cisplatin