title: Second-line treatment of recurrent HNSCC: tumor debulking in combination with high-dose-rate brachytherapy and a simultaneous cetuximab-paclitaxel protocol.
abstract: OBJECTIVE
  After the failure of first-line treatment, the clinical prognosis in head and neck cancer (HNSCC) deteriorates. Effective therapeutic strategies are limited due to the toxicity of previous treatments and the diminished tolerance of surrounding normal tissue. This study demonstrates a promising second-line regimen, with function preserving surgical tumor debulking, followed by a combination of postoperative interstitial brachytherapy and a simultaneous protocol of cetuximab and taxol.
  
  
  METHODS
  From January 2006 to May 2013, 197 patients with HNSCC were treated with brachytherapy at the University Hospital Schleswig-Holstein Campus Lübeck, including 94 patients due to recurrent cancer. Within these, 18 patients were referred to our clinic because of early progressive disease following first- or second-line treatment failure. They received the new palliative regimen. A matched-pair analysis including recurrent tumor stage, status of resection margins, tissue invasion and previous therapy was performed to evaluate this treatment retrospectively. Overall survival (OS), disease-free survival (DFS), functional outcome and treatment toxicity was analyzed on the basis of medical records and follow-up data.
  
  
  RESULTS
  DFS and OS of the study group were 8.7 and 14.8 months. Whereas, DFS and OS of the control group, treated only by function preserving tumor debulking and brachytherapy, was 3.9 and 6.1 months respectively. This demonstrates a positive trend through the additional use of the cetuximab-taxane protocol. Furthermore, no increase of therapy induced toxicities was displayed.
  
  
  CONCLUSIONS
  Pre-treated patients with a further relapse benefit from the 'cetuximab-taxane recurrency scheme'. It seems to be a valuable complement to interdisciplinary and multimodal tumor therapy, which improves OS and results in acceptable toxicity.
authors.affiliation: Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Schleswig-Holstein Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany. matthias.ritter@uksh.de.
authors.forename: M
authors.initials: M
authors.lastname: Ritter
authors.affiliation: Department of Otorhinolaryngology, Head and Neck Surgery, Asklepios Hospital Altona, Paul-Ehrlich-Straße 1, 22763, Hamburg, Germany. i.teudt@asklepios.com.
authors.forename: I U
authors.initials: IU
authors.lastname: Teudt
authors.affiliation: Department of Otorhinolaryngology, Head and Neck Surgery, Asklepios Hospital St.Georg, Lohmühlenstraße 5, 20099, Hamburg, Germany. jens.meyer@asklepios.com.
authors.forename: J E
authors.initials: JE
authors.lastname: Meyer
authors.affiliation: Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Schleswig-Holstein Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany. ursula.schroeder@uksh.de.
authors.forename: U
authors.initials: U
authors.lastname: Schröder
authors.affiliation: Interdisziplinary Brachytherapy Unit, University Hospital Schleswig-Holstein Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany. gyoergy.kovacs@uksh.de.
authors.forename: G
authors.initials: G
authors.lastname: Kovács
authors.affiliation: Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Schleswig-Holstein Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany. barbara.wollenberg@uksh.de.
authors.forename: B
authors.initials: B
authors.lastname: Wollenberg
mesh_terms: D000368:Aged; D001918:Brachytherapy / Q000379:methods*; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy* / Q000532:radiotherapy* / Q000601:surgery; D000068818:Cetuximab / Q000008:administration & dosage*; D065426:Cytoreduction Surgical Procedures; D018450:Disease Progression; D018572:Disease-Free Survival; D005260:Female; D006258:Head and Neck Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy* / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D017239:Paclitaxel / Q000008:administration & dosage*; D010166:Palliative Care / Q000379:methods; D011379:Prognosis; D012189:Retrospective Studies; D016879:Salvage Therapy; D016896:Treatment Outcome
chemical_list: D017239:Paclitaxel; D000068818:Cetuximab