O1-18-5 - Percutaneous Endoscopic Gastrostomy in Cetuximab-Combined Radiotherapy for Locally Advanced Head and Neck Cancer

Abstract

Background: Prophylactic percutaneous endoscopic gastrostomy (PEG) insertion is recommended before chemoradiotherapy (CRT) for patients with locally advanced head and neck squamous cell carcinoma (HNSCC), because severe mucositis is a common complication in CRT. We evaluate the mucosal finding and assess the necessity of prophylactic PEG insertion in head and neck cancer patients treated with radiotherapy in combination with cetuximab (Cmab).Methods: Retrospective analysis of 14 locally advanced HNSCC patients who received treatment with radiotherapy in combination with Cmab at Shizuoka Cancer Center between December 2012 and September 2013.Results: Patients' background was as following: male/female: 8/6, median age: 64.51 years (range 35-83), PS 0/1: 9/5. Primary tumor sites included oropharynx (4 patients), hypopharynx (7) and larynx (3). TPF induction chemotherapy was performed before Cmab plus RT in 6 patients. Median cycle of Cmab administration was 8. All patients received conventional RT with a median irradiation dose of 70 Gy. Thirteen patients were treated with elective neck irradiation for the elective ipsilateral (n = 3) or lilateral (n = 10) nodal levels. Grade 3/4 mucositis/stomatitis (clinical exam) occurred in 86% of patients. A median irradiation dose at the onset of Grade 3/4 mucositis was 33Gy. Eight patients represented mucositis with distinctive features; wide range of white coating lesion with clear border. Furthermore, hypopharyngeal atresia was observed in 2 patients. Grade 3/4 mucositis/stomatitis (functional/symptomatic) occurred in 79% of patients. Prophylactic PEG was inserted in 11 patients, and 11 patients actually needed PEG as nutrition support.Conclusions: Prophylactic PEG insertion is recommended in treatment with radiotherapy in combination with cetuximab for locally advanced HNSCC.