title: Concurrent use of cisplatin or cetuximab with definitive radiotherapy for locally advanced head and neck squamous cell carcinomas.
abstract: OBJECTIVE
  The goal of the present work was to compare outcomes of definitive concurrent cisplatin-based chemoradiotherapy (CRT) with cetuximab-based bioradiotherapy (BRT) in locally advanced head-and-neck squamous cell carcinoma (HNSCC).
  
  
  METHODS
  Between 2006 and 2012, 265 patients with locally advanced HNSCC were treated at our institution with CRT (n = 194; 73%) with three cycles of cisplatin (100 mg/m(2), every 3 weeks) or BRT (n = 71; 27%) with weekly cetuximab. Patients receiving BRT had more pre-existing conditions (Charlson index ≥ 2) than the CRT group (p = 0.005).
  
  
  RESULTS
  Median follow-up was 29 months. In all, 56% of patients treated with CRT received the planned three cycles (92% at least two cycles) and 79% patients treated with BRT received six cycles or more. The 2-year actuarial overall survival (OS) and progression-free survival (PFS) were 72% and 61%, respectively. In the multivariate analysis (MVA), T4 stage, N2-3 stage, smoking status (current smoker as compared with never smoker), and non-oropharyngeal locations predicted for OS, whereas BRT association with OS was of borderline significance (p = 0.054). The 2-year actuarial locoregional control (LRC) and distant control (DC) rates were 73 and 79%, respectively. CRT was independently associated with an improved LRC (2-year LRC: 76% for CRT vs. 61% for BRT) and DC (2-year LRC: 81% for CRT vs. 68% for BRT) in comparison with BRT (p < 0.001 and p = 0.01 in the MVA). Subgroup analyses showed that T4 patients benefited significantly from CRT (vs. BRT) in LRC, while T1-3 did not. BRT patients had more G3-4 skin complications (p < 0.001) and CRT patients had higher rates of feeding tube placement (p = 0.006) and G3-4 gastrointestinal toxicities (p < 0.001).
  
  
  CONCLUSIONS
  This retrospective analysis showed a better LRC in locally advanced HNSCC treated by cisplatin-based CRT than cetuximab-based BRT, and a nonsignificant trend towards an improved OS.
authors.affiliation: Department of Radiation Oncology, Gustave Roussy, 114 Rue Edouard Vaillant, 94850, Villejuif, France.
authors.forename: Antonin
authors.initials: A
authors.lastname: Levy
authors.forename: Pierre
authors.initials: P
authors.lastname: Blanchard
authors.forename: Sara
authors.initials: S
authors.lastname: Bellefqih
authors.forename: Nacéra
authors.initials: N
authors.lastname: Brahimi
authors.forename: Joël
authors.initials: J
authors.lastname: Guigay
authors.forename: François
authors.initials: F
authors.lastname: Janot
authors.forename: Stéphane
authors.initials: S
authors.lastname: Temam
authors.forename: Jean
authors.initials: J
authors.lastname: Bourhis
authors.forename: Eric
authors.initials: E
authors.lastname: Deutsch
authors.forename: Nicolas
authors.initials: N
authors.lastname: Daly-Schveitzer
authors.forename: Yungan
authors.initials: Y
authors.lastname: Tao
mesh_terms: D000368:Aged; D061067:Antibodies, Monoclonal, Humanized / Q000009:adverse effects / Q000627:therapeutic use*; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D000068818:Cetuximab; D059248:Chemoradiotherapy; D002945:Cisplatin / Q000009:adverse effects / Q000627:therapeutic use*; D018572:Disease-Free Survival; D019583:Dose Fractionation, Radiation; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D010039:Otorhinolaryngologic Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D011879:Radiotherapy Dosage; D047368:Tumor Burden / Q000187:drug effects / Q000528:radiation effects
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D000068818:Cetuximab; D002945:Cisplatin