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Concurrent Cetuximab Versus Platinum-Based Chemotherapy With Radiotherapy for Patients With Squamous Cell Carcinoma of the Head and Neck
Proceedings of the 49th Annual ASTRO Meeting
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Concurrent Cetuximab Versus Platinum-Based Chemotherapy With Radiotherapy for Patients With Squamous Cell Carcinoma of the Head and Neck
J. J. Caudell, S. M. Sawrie, S. A. Spencer, W. R. Carroll, G. E. Peters, L. M. Nabell, R. F. Meredith, J. A. Bonner University of Alabama-Birmingham, Birmingham, AL Purpose/Objective(s): The addition of platinum-based chemotherapy (ChRT) or cetuximab (CxRT) to concurrent radiotherapy (RT), compared to RT alone, has resulted in improved survival in phase III studies for locally advanced head and neck cancer (LAHNC). However, the optimal treatment regimen (CxRT vs. ChRT) has not been defined. This study retrospectively examines outcomes in patients who were treated definitively with CxRT or ChRT by the same group of physicians. Materials/Methods: From April 1997 to December 2001, 29 patients with LAHNC were treated with CxRT. All tumors were T2 or greater, had an overall stage of III or IV, and a primary in the oral cavity, oropharynx, or larynx. From May 1997 to November 2005, 67 patients were identified with similar tumor characteristics and were treated with ChRT. Patients were evaluated for loco-regional control (LRC), distant metastases free survival (DMFS), disease specific survival (DSS) and overall survival (OS). Median follow-up in patients alive at last contact was 78.5 months for CxRT patients and 32.5 months for ChRT patients. Multivariate analysis was used to assess and control for independent prognostic factors during comparative analyses. Results: Treatment groups differed significantly only in the use of altered fractionation and total dose. LRC, DMFS, and DSS were not significantly different between the two groups with 3 year actuarial rates of 70.7%, 92.4%, 76.8% for CxRT and 74.0%, 85.7%, 75.8% for ChRT, respectively. OS was significantly different (p = 0.002), with 3 year actuarial rates of 53.6% for ChRT and 75.9% for CxRT. On multi-variate analysis, CxRT was also statistically significant with respect to OS (p = 0.041); though the strongest predictor was T-stage (p = 0.006). Conclusions: In our single institution retrospective review of patients treated with CxRT or ChRT there were no significant differences in LRC, DMFS, or DSS. However, stepwise multivariate analysis revealed a suggestion of improved OS for the patients who received CxRT. Further prospective comparisons are warranted. Author Disclosure: J.J. Caudell, None; S.M. Sawrie, None; S.A. Spencer, None; W.R. Carroll, None; G.E. Peters, None; L.M. Nabell, None; R.F. Meredith, None; J.A. Bonner, Bristol Myers Squibb, ImClone, F. Consultant/Advisory Board.
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High Dose Rate Intraoperative Radiotherapy for Recurrent Head and Neck Cancer
K. Chan, D. Perry, S. L. Wolden, M. J. Zelefsky, J. Chiu, G. N. Cohen, M. Zaider, D. H. Kraus, J. P. Shah, N. Y. Lee Memorial Sloan-Kettering Cancer, New York, NY Purpose/Objective(s): Retrospective review of the use of high dose rate intraoperative radiotherapy (HDR-IORT) for recurrent head and neck cancer at a single institution. Materials/Methods: Between 7/98–2/07, 35 patients with a median age of 52 years (range 6–87) and with recurrent head and neck cancer, received 39 HDR-IORT treatments utilizing a Harrison-Anderson-Mick applicator via an Ir-192 source at our institution. A single fraction 15 Gy (range = 10–20 Gy) was delivered intraoperatively after surgical resection to the region considered at risk for close or positive margins. In 33 of the 35 treated patients, the target region was previously treated with external beam radiotherapy (median dose = 63 Gy, range 24–74 Gy). Tumor histologies (of the 39 IORT treatments) included squamous cell carcinoma (n = 18), sarcoma (n = 7), carcinoma ex-pleomorphic adenoma (n = 3), myoepithelial carcinoma (n = 3), adenocarcinoma (n = 2), adnexal carcinoma (n = 2), melanoma (n = 2), basal cell carcinoma (n = 1) and mucoepidermal carcinoma (n = 1). The 1-year estimates for in-field, local progression-free survival (LPFS), distant metastases-free survival (DMFS) and overall survival (OS) were calculated using the Kaplan-Meier method. Results: With a median follow-up of 20 months, 12 out of 35 treated patients (34%) are alive and NED. The 1-year LPFS rate is 69%, with 11 of the 39 HDR-IORT treatments (28%) resulting in in-field recurrence. The 1-year DMFS rate is 79%, with 9 out of 35 patients (26%) developing distant failure. The 1-year OS rate of the 35 treated patients is 70%, and favors patients with non-SCC histologies (81% vs. 55%, p = 0.02). Fibrosis was reported in 37% of the patients and mild to moderate trismus was reported in 23%. Among the severe complications, six patients experienced facial nerve injury/paralysis (17%), four patients developed cellulitis (11%), three patients experienced fistula or wound complications (9%), one patient developed osteoradionecrosis (3%), and one patient developed a second primary tumor (3%). Conclusions: In these preliminary results, HDR-IORT has shown encouraging local control outcomes in patients with recurrent head and neck cancer, with acceptable rates of treatment-related morbidity. Longer follow-up with a larger cohort of patients will be needed to fully assess the benefit of this procedure. Author Disclosure: K. Chan, None; D. Perry, None; S.L. Wolden, None; M.J. Zelefsky, None; J. Chiu, None; G.N. Cohen, None; M. Zaider, None; D.H. Kraus, None; J.P. Shah, None; N.Y. Lee, None.
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Dosimetric Verification in Patients Undergoing Radical Radiotherapy for Head and Neck Cancers
1
R. Height , M. Wada1, A. Rolfo2, D. Lim Joon1, C. Mantle1, M. Feigen1, C. Irvine1, V. Khoo3 1 Austin Health, Melbourne, Australia, 2Peter MacCallum Cancer Institute, Melbourne, Australia, 3Royal Marsden Hospital, Sutton, Surrey, United Kingdom Purpose/Objective(s): The development of Intensity Modulated Radiotherapy (IMRT) has prompted the need for more accurate methods of positional verification over conventional 2D imaging currently employed. Cone Beam CT (CBCT) can improve
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2447
Concurrent Cetuximab Versus Platinum-Based Chemotherapy With Radiotherapy for Patients With Squamous Cell Carcinoma of the Head and Neck
J. J. Caudell, S. M. Sawrie, S. A. Spencer, W. R. Carroll, G. E. Peters, L. M. Nabell, R. F. Meredith, J. A. Bonner University of Alabama-Birmingham, Birmingham, AL Purpose/Objective(s): The addition of platinum-based chemotherapy (ChRT) or cetuximab (CxRT) to concurrent radiotherapy (RT), compared to RT alone, has resulted in improved survival in phase III studies for locally advanced head and neck cancer (LAHNC). However, the optimal treatment regimen (CxRT vs. ChRT) has not been defined. This study retrospectively examines outcomes in patients who were treated definitively with CxRT or ChRT by the same group of physicians. Materials/Methods: From April 1997 to December 2001, 29 patients with LAHNC were treated with CxRT. All tumors were T2 or greater, had an overall stage of III or IV, and a primary in the oral cavity, oropharynx, or larynx. From May 1997 to November 2005, 67 patients were identified with similar tumor characteristics and were treated with ChRT. Patients were evaluated for loco-regional control (LRC), distant metastases free survival (DMFS), disease specific survival (DSS) and overall survival (OS). Median follow-up in patients alive at last contact was 78.5 months for CxRT patients and 32.5 months for ChRT patients. Multivariate analysis was used to assess and control for independent prognostic factors during comparative analyses. Results: Treatment groups differed significantly only in the use of altered fractionation and total dose. LRC, DMFS, and DSS were not significantly different between the two groups with 3 year actuarial rates of 70.7%, 92.4%, 76.8% for CxRT and 74.0%, 85.7%, 75.8% for ChRT, respectively. OS was significantly different (p = 0.002), with 3 year actuarial rates of 53.6% for ChRT and 75.9% for CxRT. On multi-variate analysis, CxRT was also statistically significant with respect to OS (p = 0.041); though the strongest predictor was T-stage (p = 0.006). Conclusions: In our single institution retrospective review of patients treated with CxRT or ChRT there were no significant differences in LRC, DMFS, or DSS. However, stepwise multivariate analysis revealed a suggestion of improved OS for the patients who received CxRT. Further prospective comparisons are warranted. Author Disclosure: J.J. Caudell, None; S.M. Sawrie, None; S.A. Spencer, None; W.R. Carroll, None; G.E. Peters, None; L.M. Nabell, None; R.F. Meredith, None; J.A. Bonner, Bristol Myers Squibb, ImClone, F. Consultant/Advisory Board.
2448
High Dose Rate Intraoperative Radiotherapy for Recurrent Head and Neck Cancer
K. Chan, D. Perry, S. L. Wolden, M. J. Zelefsky, J. Chiu, G. N. Cohen, M. Zaider, D. H. Kraus, J. P. Shah, N. Y. Lee Memorial Sloan-Kettering Cancer, New York, NY Purpose/Objective(s): Retrospective review of the use of high dose rate intraoperative radiotherapy (HDR-IORT) for recurrent head and neck cancer at a single institution. Materials/Methods: Between 7/98–2/07, 35 patients with a median age of 52 years (range 6–87) and with recurrent head and neck cancer, received 39 HDR-IORT treatments utilizing a Harrison-Anderson-Mick applicator via an Ir-192 source at our institution. A single fraction 15 Gy (range = 10–20 Gy) was delivered intraoperatively after surgical resection to the region considered at risk for close or positive margins. In 33 of the 35 treated patients, the target region was previously treated with external beam radiotherapy (median dose = 63 Gy, range 24–74 Gy). Tumor histologies (of the 39 IORT treatments) included squamous cell carcinoma (n = 18), sarcoma (n = 7), carcinoma ex-pleomorphic adenoma (n = 3), myoepithelial carcinoma (n = 3), adenocarcinoma (n = 2), adnexal carcinoma (n = 2), melanoma (n = 2), basal cell carcinoma (n = 1) and mucoepidermal carcinoma (n = 1). The 1-year estimates for in-field, local progression-free survival (LPFS), distant metastases-free survival (DMFS) and overall survival (OS) were calculated using the Kaplan-Meier method. Results: With a median follow-up of 20 months, 12 out of 35 treated patients (34%) are alive and NED. The 1-year LPFS rate is 69%, with 11 of the 39 HDR-IORT treatments (28%) resulting in in-field recurrence. The 1-year DMFS rate is 79%, with 9 out of 35 patients (26%) developing distant failure. The 1-year OS rate of the 35 treated patients is 70%, and favors patients with non-SCC histologies (81% vs. 55%, p = 0.02). Fibrosis was reported in 37% of the patients and mild to moderate trismus was reported in 23%. Among the severe complications, six patients experienced facial nerve injury/paralysis (17%), four patients developed cellulitis (11%), three patients experienced fistula or wound complications (9%), one patient developed osteoradionecrosis (3%), and one patient developed a second primary tumor (3%). Conclusions: In these preliminary results, HDR-IORT has shown encouraging local control outcomes in patients with recurrent head and neck cancer, with acceptable rates of treatment-related morbidity. Longer follow-up with a larger cohort of patients will be needed to fully assess the benefit of this procedure. Author Disclosure: K. Chan, None; D. Perry, None; S.L. Wolden, None; M.J. Zelefsky, None; J. Chiu, None; G.N. Cohen, None; M. Zaider, None; D.H. Kraus, None; J.P. Shah, None; N.Y. Lee, None.
2449
Dosimetric Verification in Patients Undergoing Radical Radiotherapy for Head and Neck Cancers
1
R. Height , M. Wada1, A. Rolfo2, D. Lim Joon1, C. Mantle1, M. Feigen1, C. Irvine1, V. Khoo3 1 Austin Health, Melbourne, Australia, 2Peter MacCallum Cancer Institute, Melbourne, Australia, 3Royal Marsden Hospital, Sutton, Surrey, United Kingdom Purpose/Objective(s): The development of Intensity Modulated Radiotherapy (IMRT) has prompted the need for more accurate methods of positional verification over conventional 2D imaging currently employed. Cone Beam CT (CBCT) can improve
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