Combined cetuximab and volumetric modulated arc-radiotherapy in advanced recurrent squamous cell carcinoma of the scalp

  • Uwe Wollina | uwollina@googlemail.com Department of Dermatology and Allergology, Academic Teaching Hospital Dresden-Friedrichstadt, Dresden, Germany.
  • Andreas Schreiber Department of Radiology, Academic Teaching Hospital Dresden-Friedrichstadt, Dresden, Germany.
  • Knut Merla Department of Radiology, Academic Teaching Hospital Dresden-Friedrichstadt, Dresden, Germany.
  • Gunter Haroske Institute of Pathology Georg Schmorl, Academic Teaching Hospital Dresden-Friedrichstadt, Dresden, Germany.

Abstract

A 77-year-old male patient presented with an ulcerated exophytic tumor (T2, N0, M0) with three macroscopically visible satellite metastases in the right temporo-occipital region. Mohs surgery could not control the disease due to lymphangiosis carcinomatosa and perineural infiltration, and recurrence of satellite skin metastases. Re-staging demonstrated a T2, N1, M0 profile (stage III, AJCC). Chemotherapy was limited by the patient’s co-morbidities. Therefore, we used targeted therapy with monoclonal anti-epidermal growth factor receptor antibody cetuximab in combination with volumetric modulated arc- radiotherapy (VMAT). Cetuximab was well tolerated except for the loading dose when the patient developed fever chills. To verify the correct application of VMAT, it was applied to a 3-dimensional measuring phantom prior to the patient’s first treatment session. To minimize these tolerances, patient set-up was checked and corrected by orthogonal fluoroscopic images recorded daily by the on-board imager used in our Varian accelerator. The average daily beam time was 6 min (6 arcs, 767 monitor units); the total treatment time including patient set-up and set-up correction was less than 20 min. Combined therapy was well tolerated and complete remission was achieved.

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Published
2011-12-13
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Section
Case Reports
Keywords:
Advanced squamous cell carcinoma, cetuximab, volumetric modulated arc-therapy.
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How to Cite
Wollina, U., Schreiber, A., Merla, K., & Haroske, G. (2011). Combined cetuximab and volumetric modulated arc-radiotherapy in advanced recurrent squamous cell carcinoma of the scalp. Dermatology Reports, 3(3), e57. https://doi.org/10.4081/dr.2011.e57