Impact of prophylactic percutaneous endoscopic gastrostomy tube placement on treatment tolerance in head and neck cancer patients treated with cetuximab plus radiation.
OBJECTIVE
We conducted a retrospective analysis to evaluate the efficacy and safety of cetuximab plus radiation with or without prophylactic percutaneous endoscopic gastrectomy in locally advanced squamous cell carcinoma of the head and neck patients who were not suitable to receive platinum.


METHODS
We reviewed the case records of 27 locally advanced squamous cell carcinoma of the head and neck patients treated with cetuximab plus radiation (RT) between January 2013 and July 2014. No patient was able to receive platinum because of renal dysfunction or other contraindications. Patients received an initial dose of cetuximab of 400 mg/m(2), followed by weekly doses of 250 mg/m(2). The total dose of radiotherapy was 66-70 Gy in five daily fractions of 2-2.12 Gy per week.


RESULTS
The incidence of leukopenia was significantly higher in patients without percutaneous endoscopic gastrectomy placement than in those with (67.5% vs. 7%, P = 0.002). The incidence of Grade 3 or 4 mucositis tended to be higher in patients without percutaneous endoscopic gastrectomy placement than in those with (83% vs. 47%, P = 0.058). Five of twelve patients without percutaneous endoscopic gastrectomy placement required interruption of treatment. More patients without percutaneous endoscopic gastrectomy placement had significantly >10% weight loss than patients with (75% vs. 27%, P = 0.013). The overall response rate was 56% in all patients. The 1-year progression-free survival rate was 30.6% in all patients.


CONCLUSIONS
Prophylactic percutaneous endoscopic gastrectomy-feeding tube placement could reduce the incidence of severe toxicities, including mucositis and weight loss, and avoid RT interruption. These results require confirmation in a larger study.
Department of Head and Neck Cancer Oncology, National Research Cancer Center Hospital East, Kashiwa Course of Advanced Clinical Research of Cancer, Juntendo University Graduate School of Medicine, 6-5-1 Kashiwanoha, Kashiwa, Chiba.
Tomoko
T
Yamazaki
Department of Head and Neck Cancer Oncology, National Research Cancer Center Hospital East, Kashiwa.
Tomohiro
T
Enokida
Department of Head and Neck Cancer Oncology, National Research Cancer Center Hospital East, Kashiwa.
Tetsuro
T
Wakasugi
Department of Radiation Oncology, National Cancer Research Center Hospital East, Kashiwa, Japan.
Sadamoto
S
Zenda
Department of Radiation Oncology, National Cancer Research Center Hospital East, Kashiwa, Japan.
Atsushi
A
Motegi
Department of Radiation Oncology, National Cancer Research Center Hospital East, Kashiwa, Japan.
Satoko
S
Arahira
Department of Radiation Oncology, National Cancer Research Center Hospital East, Kashiwa, Japan.
Tetsuo
T
Akimoto
Department of Head and Neck Cancer Oncology, National Research Cancer Center Hospital East, Kashiwa matahara@east.ncc.go.jp.
Makoto
M
Tahara
D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy* / Q000401:mortality / Q000532:radiotherapy; D000068818:Cetuximab / Q000627:therapeutic use*; D059248:Chemoradiotherapy / Q000009:adverse effects; D003872:Dermatitis / Q000209:etiology; D018572:Disease-Free Survival; D005260:Female; D005720:Gamma Rays / Q000627:therapeutic use; D005773:Gastroscopy; D005774:Gastrostomy; D006258:Head and Neck Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000532:radiotherapy; D006801:Humans; D007441:Intubation, Gastrointestinal; D008297:Male; D008875:Middle Aged; D052016:Mucositis / Q000209:etiology; D012189:Retrospective Studies; D015996:Survival Rate
D000068818:Cetuximab
cetuximab plus radiation; locally advanced squamous cell carcinoma of the head and neck; mucositis; percutaneous endoscopic gastrostomy; platinum refractory