Surgical wound healing in advanced head and neck cancer patients undergoing neck dissection following high dose radiation ± cetuximab

Abstract

Purpose/Objective: In recent years, several thousand patients worldwide have received epidermal growth factor receptor (EGFR) inhibitors in the context of investigational clinical trials designed to examine the anti-cancer potential for this promising class of agents. Some concern exists regarding the potential adverse impact of EGFR signaling inhibition on surgical wound healing since EGF plays a key role in wound repair and EGFR is richly expressed in normal epithelial tissues such as skin. Materials/Methods: A phase III trial comparing high dose radiation versus radiation plus cetuximab (ErbituxTM, IMC-C225) in the treatment of advanced head and neck cancer patients has recently completed patient accrual. A cohort of 115 patients enrolled from the three leading U.S. accrual centers that participated in this international trial underwent detailed evaluation of their post-radiotherapy neck dissection. From this group, 39 formal neck dissections were performed, 20 following radiation-alone and 19 following radiation plus cetuximab. Data regarding the length of hospital stay, time until removal of drainage tubes following surgery and incidence of post-operative wound complications were recorded. Results: The average length of hospital stay following neck dissection was 2.1 days in the radiation alone group versus 2.8 days in the cetuximab group. The average time until neck drain removal was 3.3 days in the radiation alone group versus 3.1 days in the cetuximab group. These results parallel findings from non-protocol head and neck cancer patients undergoing post-radiotherapy neck dissection. There were no major postoperative treatment complications identified in either group. There was one post-operative cellulitis followed by a chyle leak noted 2 months following neck dissection in a single patient from the cetuximab group. Conclusions: Approximately one-third of the head and neck cancer patients evaluated to date from this phase III trial underwent post-radiotherapy neck dissection as part of their cancer therapy. This preliminary data set suggests that the treatment of advanced head and neck cancer patients with radiation plus cetuximab does not impair surgical wound healing following formal neck dissection as compared with patients receiving radiation alone. However, it is important to recognize that patients undergoing neck dissection in this study generally completed radiation and cetuximab treatment 6–8 weeks prior to surgery. Further data derived from patients who undergo major surgery while actively receiving EGFR inhibitor therapies will be important to further investigate potential adverse effects on wound healing.