title: Tomotherapy concomitant with cetuximab, followed by cetuximab as single-agent therapy for unresectable squamous cell carcinoma of the skin: a case report.
abstract: BACKGROUND
  Cutaneous squamous cell carcinoma (SCC) is the second most frequency of all skin tumors. Incidence of SCC has risen significantly due to an increased sun exposure and the number of immunodeficient patients. Cutaneous SCC is characterized by high Epidermal growth factor receptor (EGFR) expression with low frequency of RAS mutations. Generally, locoregional surgery is curative and systemic therapy is not indicated. We evaluated the activity and toxicity profile of tomotherapy concomitant with Cetuximab, followed by Cetuximab as single agent therapy in a patient affected by unresectable, locally advanced cutaneous SCC.
  
  
  METHODS
  At our institution, on March 2012 we treated a 45 years-old patient affected by locally advanced, unresectable G1 SCC of the lumbar region. At our first observation, the patient was asthenic, with severe pain and functional limitations. There was also a superinfection due to Pseudomonas Aeruginosa resistant to antibiotics, and a G3 anemia secondary to the bleeding lesion. ECOG Performance Status was 2. Tomotherapy has been performed concomitant with the Cetuximab (400 mg/m2, followed by weekly doses of 250 mg/m2) at the total dose of 60 Gy (2 Gy/fx), followed by Cetuximab monotherapy.The lesion reduced progressively until disappear even after the suspension of the treatment and the patient achieved complete response. Toxicity resulted in G1 cutaneous rash and G2 toxicity to the nails, appeared after 5 months of treatment, typical toxicity profile of the anti-EGFR therapies. After one month of therapy the Pseudomonas Aeruginosa superinfection totally disappeared. Quality of life resulted significantly improved with reduction until discontinuation of the anti-pain drugs, and progressive increase of the hemoglobin levels. At follow up of 15 months there was no evidence of active disease and the ECOG Performance Status was 0 (zero).
  
  
  CONCLUSIONS
  The treatment was effective and feasible. Considering these excellent results, further studies about concomitant tomotherapy with Cetuximab for advanced/inoperable SCC of the skin are needed.
authors.affiliation: Dipartimento di diagnostica per immagini e Radioterapia - Seconda Università degli studi di Napoli, Piazza Miraglia, 80131 Naples, Italy. sara.falivene@gmail.com.
authors.forename: Sara
authors.initials: S
authors.lastname: Falivene
authors.forename: Francesca Maria
authors.initials: FM
authors.lastname: Giugliano
authors.forename: Antonio Maria
authors.initials: AM
authors.lastname: Grimaldi
authors.forename: Rossella
authors.initials: R
authors.lastname: Di Franco
authors.forename: Diego
authors.initials: D
authors.lastname: Toledo
authors.forename: Matteo
authors.initials: M
authors.lastname: Muto
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Cammarota
authors.forename: Valentina
authors.initials: V
authors.lastname: Borzillo
authors.forename: Paolo Antonio
authors.initials: PA
authors.lastname: Ascierto
authors.forename: Paolo
authors.initials: P
authors.lastname: Muto
mesh_terms: D061067:Antibodies, Monoclonal, Humanized / Q000009:adverse effects / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy* / Q000532:radiotherapy*; D000068818:Cetuximab; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008875:Middle Aged; D011788:Quality of Life; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects; D012878:Skin Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy*
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D000970:Antineoplastic Agents; D000068818:Cetuximab