Annals of Oncology Advance Access originally published online on September 4, 2007
Annals of Oncology 2008 19(1):142-149; doi:10.1093/annonc/mdm400
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head and neck cancer |
Consensus guidelines for the management of radiation dermatitis and coexisting acne-like rash in patients receiving radiotherapy plus EGFR inhibitors for the treatment of squamous cell carcinoma of the head and neck
1 Department of Radiation Oncology, Genolier Swiss Medical Network, Genolier, Geneva, Switzerland
2 Department of Radiation Oncology, The University of Alabama at Birmingham, Birmingham, Alabama USA
3 Department of Oncology, Universitair Ziekenhuis Antwerpen, Edegem, Belgium
4 Department of Radiation Oncology, Centre Antoine-Lacassagne, Nice, France
5 Dermatologische Klinik, Universitätsspital Zurich, Zurich, Switzerland
6 Department of Radiation Oncology, Vall d'Hebron University Hospital, Barcelona, Spain
7 Medizinische Universität Vienna, Universitätsklinik Innere Medizin I Klinische Abteilung für Onkologie, Vienna, Austria
8 The Cancer Centre, Queen Elizabeth Hospital, Birmingham, UK
9 Department of Medical Oncology, Institut Català d'Oncologia-L'Hospitalet, Barcelona, Spain
10 Service de Dermatologie, Institut Gustave Roussy, Villejuif Cedex, France
11 Department of Dermatology, University Hospital Leuven, Leuven, Belgium
12 Gilbert H. Fletcher Memorial, M.D. Anderson Cancer Center, University of Texas, Houston, Texas, USA
* Correspondence to: Dr J. Bernier, Department of Radiation Oncology, Genolier Swiss Medical Network, CH-1272 Genolier, Switzerland. Tel: +41-22-366-9959; Fax: +41-22-366-9961; E-mail: jacques.bernier{at}hcuge.ch
Background: Radiation dermatitis occurs to some degree in most patients receiving radiotherapy, with or without chemotherapy. Patients with squamous cell carcinoma of the head and neck (SCCHN) who receive radiotherapy in combination with epidermal growth factor receptor (EGFR) inhibitors, such as cetuximab, may develop a characteristic acne-like rash in addition to dermatitis.
Design: An advisory board of 11 experienced radiation oncologists, medical oncologists and dermatologists discussed the management options for skin reactions in patients receiving EGFR inhibitors and radiotherapy for SCCHN. Skin toxicity was categorised according to the National Cancer Institute—Common Terminology Criteria for Adverse Events (version 3) grading.
Results: Both general and grade-specific approaches for the management of dermatitis in this patient group are presented. It was concluded that where EGFR inhibitor-related acne-like rash and dermatitis coexist within irradiated fields, management should be based on the grade of dermatitis: for grade 1 (or no dermatitis), treatment recommendations for EGFR-related acne-like rash outside irradiated fields should be followed; for grades 2 and above, treatment recommendations for dermatitis were proposed.
Conclusions: This paper presents comprehensive consensus guidelines for the treatment of dermatitis in patients with SCCHN receiving EGFR inhibitors in combination with radiotherapy.
Key words: cetuximab, EGFR inhibitors, radiation dermatitis, radiotherapy, skin reactions, squamous cell carcinoma of the head and neck
Received for publication June 26, 2007. Revision received July 12, 2007. Accepted for publication July 12, 2007.
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