Elsevier

Radiotherapy and Oncology

Volume 90, Issue 2, February 2009, Pages 166-171
Radiotherapy and Oncology

EGFr inhibitor toxicity
High rate of severe radiation dermatitis during radiation therapy with concurrent cetuximab in head and neck cancer: Results of a survey in EORTC institutes

https://doi.org/10.1016/j.radonc.2008.09.007Get rights and content

Abstract

Objective

Examination of the rate of grade III or grade IV radiation dermatitis during treatment of head and neck cancer (HNC) with radiotherapy (RT) and concurrent cetuximab in EORTC centres.

Materials and method

A questionnaire was sent to all members of the EORTC Radiation Oncology Group and Head and Neck Group (111 institutions) to evaluate the widespread use of cetuximab and radiotherapy in HNC and to estimate the frequency of grades III and IV skin reactions in the radiation portals associated with this protocol. Co-morbidities, RT schedules and co-medications were also recorded.

Results

We received responses from 28 institutions in 11 countries. A total of 125 HNC patients from 15 institutions were treated with cetuximab and concurrent RT. Information about the skin reactions was available from 71 patients. Of these 36 had no grade III/IV adverse effects in the RT field, 15 had a grade III and 20 had grade IV radiation dermatitis. No detectable relation of grades III and IV radiation dermatitis with co-morbidities such as liver insufficiency or renal dysfunction was found.

Conclusion

According to the results of the questionnaire, grade III/IV radiation dermatitis is observed in 49% of HNC patients treated with cetuximab and concurrent RT. A systematic clinical monitoring of cutaneous side effects during RT plus cetuximab is advised to ensure the safety of this protocol.

Section snippets

Materials and methods

A formal questionnaire was developed which was composed of two parts (see Appendix). In the first part of the questionnaire, we evaluated which institutions are currently using cetuximab concurrently with radiotherapy in HNSCC patient and how many patients had been treated so far and which proportion of these patients developed grades 3–4 skin reactions within the radiation portals. In the second part of the questionnaire, details of those patients that had developed a grade III or IV skin

Results

The questionnaire was sent via E-Mail to the members of the EORTC Head and Group and Radiation Oncology Group (111 institutes). Twenty-eight institutes from eleven countries (United Kingdom, Belgium, the Netherlands, Spain, Austria, Switzerland, Italy, France, Germany, Serbia, Israel) responded. One Institute retracted their data (Vienna). Fifteen out of these 28 institutions (54%) indicated that they had been treating HNSCC patients with radiotherapy and concurrent cetuximab. In case of

Discussion

The results of this survey indicate that grades III and IV radiation dermatitis occurs in approximately 49% of HNSCC patients treated with radiotherapy and concurrent cetuximab. The incidence of these severe skin reactions is twice as high compared to that reported by Bonner et al. [1]. Even more cumbersome is the high rate of grade IV skin reactions – 28% – within the radiation portals, because these severe reactions are potentially hazardous due to secondary local and systemic infections [2].

Conclusion

The results of this survey indicate that the concurrent use of cetuximab during radiotherapy of head and neck cancer maybe associated with a high incidence of severe (grade III/IV) radiation dermatitis. Close monitoring for the occurrence of such severe skin reactions within the radiation portals is necessary and interruption of further treatment with cetuximab during radiotherapy is recommended in case of early grade III–IV radiation dermatitis. In future trials in which cetuximab is combined

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