Toxicities Following Stereotactic Ablative Radiotherapy Treatment of Locally-Recurrent and Previously-Irradiated Head and Neck Squamous Cell Carcinoma

• Published in: Seminars in radiation oncology Vol. 26; no. 2; pp. 112 - 119
• Main Authors: Quan, Kimmen, MD, Xu, Karen M., BS, Zhang, Yongqian, PhD, Clump, David A., MD, Flickinger, John C., MD, Lalonde, Ron, PhD, Burton, Steven A., MD, Heron, Dwight E., MD, FACRO
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-04-2016
• Subjects: Aged; Aged, 80 and over; Antineoplastic Agents - therapeutic use; Carcinoma, Squamous Cell - drug therapy; Carcinoma, Squamous Cell - radiotherapy; Cetuximab - therapeutic use; Combined Modality Therapy; Dose-Response Relationship, Radiation; Female; Head and Neck Neoplasms - drug therapy; Head and Neck Neoplasms - radiotherapy; Hematology, Oncology and Palliative Medicine; Humans; Male; Middle Aged; Neoplasm Recurrence, Local - drug therapy; Neoplasm Recurrence, Local - radiotherapy; Pilot Projects; Radiation Injuries - epidemiology; Radiology; Radiosurgery - adverse effects; Radiosurgery - statistics & numerical data; Radiotherapy Dosage; Radiotherapy Planning, Computer-Assisted - methods; Retreatment; Treatment Outcome
• ISSN: 1053-4296; 1532-9461
• DOI: 10.1016/j.semradonc.2015.11.007

Stereotactic ablative radiotherapy (SABR) with concomitant cetuximab is an effective treatment option for previously-irradiated, locally-recurrent squamous cell carcinoma of the head and neck (rSCCHN). Its local control and overall survival are similar to those of other available treatment options. Each re-treatment depends heavily on the prior treatment and every patient is a special case. Based on our institution’s experience and previously published studies, for patients who receive concomitant cetuximab with a median prior radiation therapy (RT) dose of 70 Gy, we recommend a total dose of 40–44 Gy delivered in 5 fractions on alternating days over 1-2 weeks. However, Grade 2 or 3 toxicities are not uncommon. Therefore, in this review we also report a pilot study that applies a normal tissue complication probability (NTCP) dose-response model to estimate the probability of toxicities in locally-rSCCHN re-irradiated with SABR. Although this dose-response model includes concurrent targeted therapy and no comparable model yet exists for SABR without it, complication rates without concurrent biological therapy or chemotherapy should be no higher than those described here.