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4 results

  • The potential role of imaging techniques in avoiding neck dissection during salvage surgery after head and neck carcinoma treated with bioradiotherapy

  • A Rovira, J Tornero, M Taberna, M Oliva, R Montal, J Nogues, A Mari, J M Viñals, A Lozano, M Maños, R Mesia
  • Journal:
    The Journal of Laryngology & Otology / Volume 135 / Issue 11 / November 2021
    Published online by Cambridge University Press:
    06 September 2021, pp. 970-975
    Print publication:
    November 2021
  • Objective

    This study aimed to evaluate the effectiveness of computed tomography and positron emission tomography-computed tomography prior to salvage surgery after head and neck carcinoma treated with bioradiotherapy and to look at the role of neck dissection in this setting.

    Method

    This study was a retrospective chart review of a series of consecutive patients with locally advanced head and neck squamous cell carcinoma treated with bioradiotherapy. Radiological and pathological stages were compared to evaluate the accuracy of computed tomography and positron emission tomography-computed tomography in detecting occult neck metastasis in the context of recurrence of primary tumour. In order to assess the impact of neck dissection on survival, Kaplan–Meier survival curves after salvage surgery with and without neck dissection were derived.

    Results

    A total of 268 patients were identified, of which 22 underwent salvage surgery. The negative predictive value of computed tomography and positron emission tomography-computed tomography was excellent. Neck dissection did not represent an improvement on overall, disease specific and regional recurrence free survival (p = 0.67, p = 0.91 and p = 0.62, respectively) amongst clinically and radiologically negative necks.

    Conclusion

    Conservative treatment of the neck should be considered when dealing with patients with primary site recurrence or persistent disease after bioradiotherapy without evidence of neck disease.

  • Cetuximab in the management of nasopharyngeal carcinoma – a narrative review

  • M S Iqbal, D Wilkinson, A Tin, P Bossi, L Gradwell-Nelson, J Kovarik, J O'Hara, C Kelly
  • Journal:
    The Journal of Laryngology & Otology / Volume 133 / Issue 10 / October 2019
    Published online by Cambridge University Press:
    11 September 2019, pp. 843-855
    Print publication:
    October 2019
  • Background

    Concurrent chemotherapy with radiotherapy is the standard treatment for locoregionally advanced nasopharyngeal cancer. Cetuximab can be used in the treatment of head and neck squamous cell carcinoma. However, the randomised studies that led to approval for its use in this setting excluded nasopharyngeal cancer. In the context of limited data for the use of cetuximab in nasopharyngeal cancer in the medical literature, this review aimed to summarise the current evidence for its use in both primary and recurrent or metastatic disease.

    Method

    A literature search was performed using the keywords ‘nasopharyngeal neoplasm’, ‘cetuximab’ and ‘Erbitux’.

    Results

    Twenty studies were included. There were no randomised phase III trials, but there were nine phase II trials. The use of cetuximab in the treatment of nasopharyngeal carcinoma has been tested in various settings, including in combination with induction chemotherapy and concurrent chemoradiotherapy, and in the palliative setting.

    Conclusion

    There is no evidence of benefit from the addition of cetuximab to standard management protocols, and there is some evidence of increased toxicity. There is more promise for its use in metastatic or locally recurrent settings. This review draws together the existing evidence and could provide a focus for future studies.

  • Cetuximab: a critical appraisal of a novel development in the treatment of squamous cell carcinoma of the head and neck

  • Joanna Gemmill
  • Journal:
    Journal of Radiotherapy in Practice / Volume 7 / Issue 1 / March 2008
    Published online by Cambridge University Press:
    01 March 2008, pp. 1-7

  • Recently published evidence has shown an improvement in locoregional control and a survival advantage in the treatment of squamous cell carcinomas of the head and neck (SCCHN) using cetuximab, a monoclonal antibody that inhibits the tumour-promoting mechanism of the epidermal growth factor receptor (EGFR). In a large randomised trial, cetuximab was delivered concurrently with radiotherapy and compared to radiotherapy alone in locally advanced SCCHN. The trial showed that the addition of cetuximab offers improved locoregional control and survival without enhancing acute toxicity compared to radiotherapy alone. These exciting results have the potential to change standard head and neck cancer practice, impacting on head and neck cancer services provided by oncology departments and multidisciplinary working.

    This article aims to define the mechanism of action of cetuximab, critically appraise the evidence for the use of cetuximab within Oncology departments for SCCHN, and critically evaluate how cetuximab may impact on current practice. Future possibilities and trials to assess the use of cetuximab within clinical practice will also be discussed.