title: Experience with combination of cetuximab plus intensity-modulated radiotherapy with or without chemotherapy for locoregionally advanced nasopharyngeal carcinoma.
abstract: OBJECTIVE
  To evaluate the safety and efficacy of cetuximab plus intensity-modulated radiotherapy (IMRT) with or without chemotherapy for locoregionally advanced nasopharyngeal carcinoma (NPC).
  
  
  METHODS
  From June 2007 to December 2010, 33 patients with stage II (12 %), III (33 %), IVA (33 %), and IVB (21 %) NPC were treated at our hospital. Cetuximab was administered at an initial dose of 400 mg/m(2) followed by weekly doses of 250 mg/m(2). All patients completed IMRT, and a total dose of 66-70.4, 66, 60, and 54 Gy were given to the gross tumor volume, positive neck nodes, high-risk clinical target volume, and low-risk clinical target volume, respectively. Most patients (90.9 %) received platinum-based neoadjuvant, concurrent, or adjuvant chemotherapy. The efficacy and safety were evaluated retrospectively.
  
  
  RESULTS
  With a median follow-up of 40.0 months, the 3-year progression-free survival (PFS), distant metastasis-free survival, and overall survival were 70.5 % (95 % CI 54.0-87.0 %), 83.6 % (95 % CI 70.3-96.9 %), and 90.9 % (95 % CI 81.1-100.0 %), respectively. Majority (75.8 %) of patients received ≥ 7 cycles of cetuximab (median 7 cycles, range 2-14 cycles). Patients who received ≥ 7 cycles of cetuximab showed a better 3-year PFS than those receiving <7 cycles (79.1 vs. 31.2 %, p = 0.050). During cetuximab + IMRT, stomatitis was the most common acute treatment toxicity, 23 (69.7 %) and 5 (15.2 %) patients with grade 3 and grade 4 stomatitis, respectively. Temporal lobe necrosis was observed in 7 patients.
  
  
  CONCLUSIONS
  Cetuximab plus IMRT with or without chemotherapy for locoregionally advanced NPC is effective and tolerated. Further investigations are warranted.
authors.affiliation: Department of Radiation Oncology, Shanghai Cancer Center of Fudan University, 270 Dong'an Road, Shanghai, 200032, China.
authors.forename: Xiaoshuang
authors.initials: X
authors.lastname: Niu
authors.forename: Chaosu
authors.initials: C
authors.lastname: Hu
authors.forename: Lin
authors.initials: L
authors.lastname: Kong
mesh_terms: D000328:Adult; D000368:Aged; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage / Q000009:adverse effects; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D002277:Carcinoma; D000068818:Cetuximab; D017024:Chemotherapy, Adjuvant; D002945:Cisplatin / Q000008:administration & dosage / Q000009:adverse effects; D003131:Combined Modality Therapy; D003872:Dermatitis / Q000209:etiology; D004334:Drug Administration Schedule; D005076:Exanthema / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D007970:Leukopenia / Q000209:etiology; D008297:Male; D008875:Middle Aged; D000077274:Nasopharyngeal Carcinoma; D009303:Nasopharyngeal Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy*; D011879:Radiotherapy Dosage; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D000068818:Cetuximab; D002945:Cisplatin