Severe radiation dermatitis in patients with locally advanced head and neck cancer treated with concurrent radiation and cetuximab.

OBJECTIVES: A phase III trial has shown the superiority of concurrent cetuximab and radiotherapy versus radiotherapy alone for the treatment of locally advanced head and neck cancer (HNC). We evaluated our institution's experience of patients treated with concurrent cetuximab and radiotherapy to determine the rate of serious (≥ grade 3) radiation dermatitis. We also sought to more fully describe and characterize the grade 4 dermatitis that these patients develop.
METHODS: We performed a retrospective review of HNC patients who were treated with concurrent cetuximab and radiation. We included patients treated in either the definitive or loco-regionally recurrent setting with nonmetastatic disease who received their first dose of cetuximab from March 1, 2006 to January 1, 2008. We found 115 patients who fit our search.
RESULTS: Serious radiation dermatitis was noted in 26 (23%) patients, with 22 patients developing grade 3 dermatitis and 4 patients developing grade 4 dermatitis. All 4 patients who developed grade 4 dermatitis did so within the radiation field. The dermatitis was manifested by spontaneous bleeding from the involved skin, and in 1 case, skin necrosis. These toxicities developed during the fifth week of treatment.
CONCLUSIONS: Treatment with concurrent radiation and cetuximab for locally advanced HNC is a relatively new treatment modality, and the toxicities of this regimen are becoming better understood. We believe that the serious skin toxicities that these patients develop when treated with concomitant cetuximab occur more frequently than when patients are treated with concurrent cisplatin, although further study is needed to confirm this.