Experience with combination of cetuximab plus intensity-modulated radiotherapy with or without chemotherapy for locoregionally advanced nasopharyngeal carcinoma

To evaluate the safety and efficacy of cetuximab plus intensity-modulated radiotherapy (IMRT) with or without chemotherapy for locoregionally advanced nasopharyngeal carcinoma (NPC). From June 2007 to December 2010, 33 patients with stage II (12 %), III (33 %), IVA (33 %), and IVB (21 %) NPC were treated at our hospital. Cetuximab was administered at an initial dose of 400 mg/m(2) followed by weekly doses of 250 mg/m(2). All patients completed IMRT, and a total dose of 66-70.4, 66, 60, and 54 Gy were given to the gross tumor volume, positive neck nodes, high-risk clinical target volume, and low-risk clinical target volume, respectively. Most patients (90.9 %) received platinum-based neoadjuvant, concurrent, or adjuvant chemotherapy. The efficacy and safety were evaluated retrospectively. With a median follow-up of 40.0 months, the 3-year progression-free survival (PFS), distant metastasis-free survival, and overall survival were 70.5 % (95 % CI 54.0-87.0 %), 83.6 % (95 % CI 70.3-96.9 %), and 90.9 % (95 % CI 81.1-100.0 %), respectively. Majority (75.8 %) of patients received a parts per thousand yen7 cycles of cetuximab (median 7 cycles, range 2-14 cycles). Patients who received a parts per thousand yen7 cycles of cetuximab showed a better 3-year PFS than those receiving < 7 cycles (79.1 vs. 31.2 %, p = 0.050). During cetuximab + IMRT, stomatitis was the most common acute treatment toxicity, 23 (69.7 %) and 5 (15.2 %) patients with grade 3 and grade 4 stomatitis, respectively. Temporal lobe necrosis was observed in 7 patients. Cetuximab plus IMRT with or without chemotherapy for locoregionally advanced NPC is effective and tolerated. Further investigations are warranted.