Second-line treatment of recurrent HNSCC: tumor debulking in combination with high-dose-rate brachytherapy and a simultaneous cetuximab-paclitaxel protocol.

M Ritter,G Kovács,B Wollenberg,U Schröder,J E Meyer,I U Teudt

doi:10.1186/s13014-016-0583-0

Abstract

Background and purposeAfter the failure of first-line treatment, the clinical prognosis in head and neck cancer (HNSCC) deteriorates. Effective therapeutic strategies are limited due to the toxicity of previous treatments and the diminished tolerance of surrounding normal tissue. This study demonstrates a promising second-line regimen, with function preserving surgical tumor debulking, followed by a combination of postoperative interstitial brachytherapy and a simultaneous protocol of cetuximab and taxol.Patients and methodsFrom January 2006 to May 2013, 197 patients with HNSCC were treated with brachytherapy at the University Hospital Schleswig-Holstein Campus Lübeck, including 94 patients due to recurrent cancer. Within these, 18 patients were referred to our clinic because of early progressive disease following first- or second-line treatment failure. They received the new palliative regimen. A matched-pair analysis including recurrent tumor stage, status of resection margins, tissue invasion and previous therapy was performed to evaluate this treatment retrospectively. Overall survival (OS), disease-free survival (DFS), functional outcome and treatment toxicity was analyzed on the basis of medical records and follow-up data.ResultsDFS and OS of the study group were 8.7 and 14.8 months. Whereas, DFS and OS of the control group, treated only by function preserving tumor debulking and brachytherapy, was 3.9 and 6.1 months respectively. This demonstrates a positive trend through the additional use of the cetuximab-taxane protocol. Furthermore, no increase of therapy induced toxicities was displayed.ConclusionPre-treated patients with a further relapse benefit from the ‘cetuximab-taxane recurrency scheme’. It seems to be a valuable complement to interdisciplinary and multimodal tumor therapy, which improves OS and results in acceptable toxicity.Electronic supplementary materialThe online version of this article (doi:10.1186/s13014-016-0583-0) contains supplementary material, which is available to authorized users.

Highlights

Background and purposeAfter the failure of first-line treatment, the clinical prognosis in head and neck cancer (HNSCC) deteriorates
Disease-free survival (DFS) and overall survival (OS) of the control group, treated only by function preserving tumor debulking and brachytherapy, was 3.9 and 6.1 months respectively. This demonstrates a positive trend through the additional use of the cetuximab-taxane protocol
Patients and methods From January 2006 to May 2013, we retrospectively reviewed 94 patients with recurrent head and neck cancer treated with postoperative interstitial high-dose-rate brachytherapy (HDR-BT) at the University Hospital Schleswig-Holstein Campus Lübeck

Summary

Introduction

After the failure of first-line treatment, the clinical prognosis in head and neck cancer (HNSCC) deteriorates. This study demonstrates a promising second-line regimen, with function preserving surgical tumor debulking, followed by a combination of postoperative interstitial brachytherapy and a simultaneous protocol of cetuximab and taxol. Treatment options for locally recurrent or persistent head and neck squamous cell carcinoma (HNSCC) are limited. Reported studies of re-irradiation with concurrent chemotherapy show high rates of locoregional control (LC) (25-30 %) and improved overall survival (OS) (10-30 % at 2 years), dependent on patient selection and treatment regimen. Single-agent platinum chemotherapy stays the common standard for locally advanced recurrences. Disease-free survival (DFS) averages at 3 to 5 months and mean OS at 5 to 7 months [1, 6]. Mean OS remains low with an average of 9 months [7, 8]

Methods

Results

Discussion

Conclusion