title: Distinctive mucositis and feeding-tube dependency in cetuximab plus radiotherapy for head and neck cancer.
abstract: OBJECTIVE
  Prophylactic percutaneous endoscopic gastrostomy may be considered before chemoradiotherapy for patients with locally advanced head and neck squamous cell carcinoma, because severe mucositis is a common complication. We evaluated the mucosal findings and necessity of prophylactic percutaneous endoscopic gastrostomy in patients with head and neck squamous cell carcinoma receiving cetuximab and radiotherapy.
  
  
  METHODS
  Fourteen consecutive patients with locally advanced head and neck squamous cell carcinoma receiving cetuximab and radiotherapy were analyzed.
  
  
  RESULTS
  Patients' backgrounds were as follows: male/female, 8/6; median age, 64.5 years (range, 35-83 years); performance status, 0/1, 9/5. Primary tumor sites included the oropharynx, hypopharynx and larynx in four, seven and three patients, respectively. Patients completed a median of eight cetuximab cycles. All patients received three-dimensional conformal radiotherapy (median dose, 70 Gy). Thirteen patients were treated with elective neck irradiation at the ipsilateral (n = 3) or bilateral (n = 10) nodes. Grade ≥ 3 mucositis/stomatitis (clinical examination) occurred in 85.7% patients (n = 12). The median irradiation dose was 33 Gy at the Grade 3 mucositis onset. Eight patients showed mucositis with distinctive features, a wide range of white-coated lesions with a clear border; hypopharyngeal atresia was observed in two patients. Prophylactic percutaneous endoscopic gastrostomy was performed in 11 patients, and 11 patients (78.6%) actually required nutritional support because of Grade ≥ 3 mucositis/stomatitis (functional/symptomatic).
  
  
  CONCLUSIONS
  Prophylactic percutaneous endoscopic gastrostomy is recommended because most patients receiving cetuximab and radiotherapy for locally advanced head and neck squamous cell carcinoma have Grade ≥ 3 mucositis with distinctive features.
authors.affiliation: Division of Gastrointestinal Oncology, Shizuoka Cancer Center, Shizuoka t.yokota@scchr.jp.
authors.forename: Tomoya
authors.initials: T
authors.lastname: Yokota
authors.affiliation: Division of Radiation Oncology, Shizuoka Cancer Center, Shizuoka.
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Onoe
authors.affiliation: Division of Radiation Oncology, Shizuoka Cancer Center, Shizuoka.
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Ogawa
authors.affiliation: Division of Gastrointestinal Oncology, Shizuoka Cancer Center, Shizuoka.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Hamauchi
authors.affiliation: Division of Head and Neck Surgery, Shizuoka Cancer Center, Shizuoka.
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Iida
authors.affiliation: Division of Head and Neck Surgery, Shizuoka Cancer Center, Shizuoka.
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Kamijo
authors.affiliation: Division of Head and Neck Surgery, Shizuoka Cancer Center, Shizuoka.
authors.forename: Toshihito
authors.initials: T
authors.lastname: Suda
authors.affiliation: Division of Dentistry and Oral Surgery, Shizuoka Cancer Center, Shizuoka, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Yurikusa
authors.affiliation: Division of Radiation Oncology, Shizuoka Cancer Center, Shizuoka.
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Nishimura
authors.affiliation: Division of Gastrointestinal Oncology, Shizuoka Cancer Center, Shizuoka.
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Yasui
authors.affiliation: Division of Head and Neck Surgery, Shizuoka Cancer Center, Shizuoka.
authors.forename: Tetsuro
authors.initials: T
authors.lastname: Onitsuka
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage / Q000009:adverse effects*; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy*; D000068818:Cetuximab; D059248:Chemoradiotherapy / Q000009:adverse effects; D004750:Enteral Nutrition; D005260:Female; D005773:Gastroscopy; D005774:Gastrostomy / Q000379:methods; D006258:Head and Neck Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy*; D006801:Humans; D007441:Intubation, Gastrointestinal; D008297:Male; D008875:Middle Aged; D052016:Mucositis / Q000139:chemically induced / Q000209:etiology* / Q000473:pathology; D009367:Neoplasm Staging; D011879:Radiotherapy Dosage; D020266:Radiotherapy, Conformal / Q000009:adverse effects*; D012720:Severity of Illness Index; D013280:Stomatitis / Q000139:chemically induced / Q000209:etiology* / Q000473:pathology
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D000970:Antineoplastic Agents; D000068818:Cetuximab
keywords: cetuximab; locally advanced squamous cell carcinoma of the head and neck; mucositis; percutaneous endoscopic gastrostomy; radiotherapy