Abstract
Simple SummaryDespite recent developments in immune checkpoint inhibitors, the treatment of locoregionally recurrent head and neck squamous cell cancer (HNSCC) remains challenging. Prospective data comparing re-irradiation with systemic treatment are not available. The SOCCER trial represents a prospective non-interventional multicenter trial that enrolled patients with locoregionally recurrent HNSCC treated with cetuximab in combination with re-radiotherapy or chemotherapy. A total of 192 patients were analyzed. Radiotherapy combined with cetuximab had superior progression-free and overall survival compared to chemotherapy with cetuximab. This highlights the high efficacy of local re-radiotherapy in combination with cetuximab in patients with locoregionally recurrent HNSCC.Treatment options of locoregional recurrent head and neck squamous cell cancer (HNSCC) include both local strategies as surgery or re-radiotherapy and systemic therapy. In this prospective, multi-center, non-interventional study, patients were treated either with platinum-based chemotherapy and cetuximab (CT + Cet) or re-radiotherapy and cetuximab (RT + Cet). In the current analysis, progression-free survival (PFS) and overall survival (OS) were compared in patients with locoregional recurrence. Four hundred seventy patients were registered in 97 German centers. After exclusion of patients with distant metastases, a cohort of 192 patients was analyzed (129 CT + Cet, 63 RT + Cet). Radiotherapy was delivered as re-irradiation to 70% of the patients. The mean radiation dose was 51.8 Gy, whereas a radiation dose of ≥60 Gy was delivered in 33% of the patients. Chemotherapy mainly consisted of cisplatin/5-flurouracil (40%) or carboplatin/5-flurouracil (29%). The median PFS was 9.2 months in the RT + Cet group versus 5.1 months in the CT + Cet group (hazard ratio for disease progression or death, 0.40, 95% CI, 0.27–0.57, p < 0.0001). Median OS was 12.8 months in the RT + Cet group versus 7.9 months in the CT + Cet group (hazard ratio for death, 0.50, 95% CI, 0.33–0.75, p = 0.0008). In conclusion, radiotherapy combined with cetuximab improved survival compared to chemotherapy combined with cetuximab in locally recurrent HNSCC.
Highlights
Patients with locally advanced head and neck squamous cell cancer (HNSCC) are routinely treated with chemoradiotherapy either alone or adjuvant after surgery
The estimated 1-year progression-free survival (PFS) rate was 28% (95% confidence interval (CI), 16–41) in the RT + Cet group compared to 7% in the CT + Cet group
DiTscreuastsmioennt options for patients with loco-regional recurrent HNSCC include salvage surgeTrrye, aretm-raendtiootphteiroanpsyf,oarnpdastyiesntetms wicithelroacpoy-r. eSgailovnaaglerseucurgrereryntfrHeqNuSeCnCtlyinisclnuodtepsoaslsviabglee dsuuregteoryit,sretr-eratdmioetnhte-realpayte, danmdosrybsitdeimtyi.cInthtehriaspsyu.bSgarlovuapgeasnuarlgyseirsyoffrethqeueSnOtClyCisEnRosttpuodsys, itbhlee cdluasestiocailtfis rtsrtealitnmeecnhte-rmeloattheedrampoyrcboidnsitiyst.iInng tohfisplsautbingurmou,p5-aflnuarloyusirsacoifl,tahnedScOeCtuCxEimRasbtuwdays, cthoemcplaasresidcatol friarsdtiolitnheercahpeymaonthdecreatpuyxicmonasbi.sting of platinum, 5-flurouracil, and cetuximab was compared to radiotherapy and cetuximab
Summary
Patients with locally advanced head and neck squamous cell cancer (HNSCC) are routinely treated with chemoradiotherapy either alone or adjuvant after surgery. Survivors have a more than ten-fold increased risk of developing a secondary primary tumor in the head and neck compared to the normal population [4] Treatment options for these patients include local approaches such as salvage surgery, re-radiotherapy or re-radiotherapy combined with chemotherapy or cetuximab. The question of local or systemic treatment remains highly relevant even after the approval of several immune checkpoint inhibitors Among these treatment options, salvage surgery showed a survival benefit and should be recommended as treatment of choice [8,9]. The aim of this analysis is to detect differences in progression-free and overall survival between both treatment schemes
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