title: Adjuvant stereotactic body radiotherapy±cetuximab following salvage surgery in previously irradiated head and neck cancer.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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/m2 day -7+250 mg/m2 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.
  
  
  METHODS
  4.
authors.affiliation: Department of Radiation Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania, U.S.A.
authors.forename: John A
authors.initials: JA
authors.lastname: Vargo
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Kubicek
authors.forename: Robert L
authors.initials: RL
authors.lastname: Ferris
authors.forename: Umamaheswar
authors.initials: U
authors.lastname: Duvvuri
authors.forename: Jonas T
authors.initials: JT
authors.lastname: Johnson
authors.forename: James
authors.initials: J
authors.lastname: Ohr
authors.forename: David A
authors.initials: DA
authors.lastname: Clump
authors.forename: Steven
authors.initials: S
authors.lastname: Burton
authors.forename: Dwight E
authors.initials: DE
authors.lastname: Heron
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000627:therapeutic use; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D000068818:Cetuximab; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D066246:ErbB Receptors; D005260:Female; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology / Q000628:therapy*; D009367:Neoplasm Staging; D011788:Quality of Life; D016634:Radiosurgery / Q000379:methods*; D011879:Radiotherapy Dosage; D018714:Radiotherapy, Adjuvant / Q000379:methods; D012189:Retrospective Studies; D016879:Salvage Therapy / Q000379:methods*; D000077195:Squamous Cell Carcinoma of Head and Neck; D015996:Survival Rate / Q000639:trends; D014481:United States / Q000453:epidemiology
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D000970:Antineoplastic Agents; D066246:ErbB Receptors; D000068818:Cetuximab
keywords: Stereotactic body radiation therapy; cetuximab; recurrent head and neck cancer; reirradiation; salvage surgery