Cetuximab and radiation for primary and recurrent squamous cell carcinoma of the head and neck (SCCHN) in the elderly and multi-morbid patient: a single-centre experience.

BACKGROUND: Chemoradiotherapy for head and neck cancer (SCCHN) is challenging in elderly, multi-morbid patients. Radioimmunotherapy (RIT) with cetuximab provides an option to enhance efficacy of radiotherapy without increased toxicity. We present a single-centre experience of RIT these patients. METHODS: Toxicity and outcome was retrospectively analysed in patients treated with radiotherapy and cetuximab between 2006 and 2009. Treatment response was analysed at first follow-up, outcome was estimated using Kaplan-Meier analyses. RESULTS: 73 patients with primary/recurrent SCCHN were treated (re-irradiation: 22 patients). CTC grade 3 allergic reactions occurred in 4 patients, grade 3 acneiforme skin reactions leading to discontinuation of cetuximab in 3 patients.Overall response rate was 59,4%, median locoregional and overall progression-free survival (PFS) was 18 and 15 months, overall survival (OS) 18 months. CONCLUSION: RIT is a feasible treatment option for elderly and multi-morbid patients with promising therapeutic activity. Long-term disease control can also be achieved in patients receiving RIT for re-irradiation.

Patterns of failure and local control after intraoperative electron boost radiotherapy to the presacral space in combination with total mesorectal excision in patients with locally advanced rectal cancer.

PURPOSE: To evaluate local control and patterns of failure in patients treated with intraoperative electron beam radiotherapy (IOERT) after total mesorectal excision (TME), to appraise the effectiveness of intraoperative target definition. METHODS AND MATERIALS: We analyzed the outcome of 243 patients with rectal cancer treated with IOERT (median dose, 10 Gy) after TME. Eighty-eight patients received neoadjuvant and 122 patients adjuvant external beam radiotherapy (EBRT) (median dose, 41.4 Gy), and in 88% simultaneous chemotherapy was applied. Median follow-up was 59 months. RESULTS: Local failure was observed in 17 patients (7%), resulting in a 5-year local control rate of 92%. Only complete resection and absence of nodal involvement correlated positively with local control. Considering IOERT fields, seven infield recurrences were seen in the presacral space, resulting in a 5-year local control rate of 97%. The remaining local relapses were located as follows: retrovesical/retroprostatic (5), anastomotic site (2), promontorium (1), ileocecal (1), and perineal (1). CONCLUSION: Intraoperative electron beam radiotherapy as part of a multimodal treatment approach including TME is a highly effective regimen to prevent local failure. The presacral space remains the site of highest risk for local failure, but IOERT can decrease the percentage of relapses in this area.