Table 7:
Treatment of Recurrent FA-HNSCC
| Patient | Age (time to recurrence) | Sex | FA Group | SCT (Age) | Recurrence site | Surgical Resection | Systemic Agents (Dose) | RT Dose | Toxicities | Interruption or Termination of CRT | Outcome | Second Recurrence |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Lewis 202097 [Recurrence #1] |
27 (8 mo pS1) | F | G | No | Level 1B lymph nodes with masseter invasion (oral cavity primary) | Yes (S2) | Pembrolizumab every 21 days | [IMRT] 60 Gy total (200 cGy daily x30 fractions), escalated from 50 cGy x5 fractions | Mucositis (grade 2), dermatitis (grade 1), oropharyngeal pain, xerostomia, mild trismus | No | (see below) | Yes* [Table 7] |
| Lewis 202097 [Recurrence #2] |
28 (10 mo pS2, 7 mo pRT) | F | G | No | Maxillary gingiva (oral cavity primary) | Yes (S3) | Pembrolizumab every 21 days | - | Well tolerated | Ongoing | NED (4 mo pS3) | - |
| Lach #1 (2020)48 | 51 (6 mo pS) | M | A | No | Mediastinum (esophageal primary) | No | Capecitabine initially, then oxaliplatin and 5-FU (doses NA) | - | Diarrhea, acute pericarditis | Yes (CT terminated) | DOD (<6 mo pCT) | - |
| Beckham #5 (2019)65 | 37 (8 mo pS) | M | - | No | Pretracheal soft tissue, dermal metastasis (oral cavity primary) | No | Concurrent cetuximab ×2 doses; cetuximab alone after RT termination (dose NA) | 42.4 Gy total (in 20 fractions) | Mucositis (grade 3), dermatitis (grade 4), pancytopenia, xerostomia, abscess, bleeding | Yes (cetuximab and RT terminated) | DOD (20 mo pD, 17 mo pS, 7 mo pRT) | - |
| Beckham #8 (2019)65 | 33 (3 mo pCRT) | M | C | Yes (17) | Cavernous sinus (pharyngeal primary) | No | Nivolumab (3 mg/kg x3 doses) | [IMRT] 30 Gy total (in 10 fractions) | Nivolumab encephalitis, aspiration pneumonia | Yes (died during nivolumab therapy), RT completed | DOD (12 mo pD, 10 mo pS, 7 mo pRT) | - |
| Beckham #9 (2019)65 | 36 (NA pS1) | F | A | No | Retropharyngeal space and base of skull (oral cavity primary) | Yes (S2) | Cetuximab (dose NA) with RT cycles 1 + 2, cetuximab and paclitaxel (20 mg/m^2) with RT cycle 3, tremelimumab (1 mg/kg) and durvalumab (20 mg/kg) after RT completion | 3.7 Gy BID ×2 days (3 cycles) | Carotid bleed | No | DOD (77 mo pD, 8 mo pS2, 2 mo pRT) | - |
| Nolan 2017100 | 39 (8 yr pRT) | M | - | Yes (12) | Tongue with BOT extension (oral cavity primary) | Yes (S2) | [Neoadjuvant] Cisplatin, 5-FU, Cetuximab (doses NA, “80% reduced”) x2 cycles | - | Neutropenic sepsis | Yes (CT and CTX terminated) | DOD (9 yr pD) | Yes |
| Wong 201386 | 21 (3 mo pS1) | M | - | No | Oral tongue and BOT with extensive invasion (oral cavity primary) | Yes (S2) | Cetuximab (400 mg/m^2 loading dose, 200 mg/m^2 once weekly x8 total infusions) | 70.2 Gy total to oral cavity, 50.4 Gy total to neck (fractions of 180 cGy) | Mucositis (grade 3) by 4500 cGy, dermatitis with desquamation (grade 3) by 5000 cGy, neutropenia (after cetuximab loading dose), acneiform rash (after second infusion) | Yes (cetuximab terminated), RT completed | DOD (10 wk pRT) | Yes |
| Masserot #7 (2008)64 | 18 (6 mo pS) | M | - | Yes (11.2) | Pelvilingual (oral cavity primary) | No | Agent(s) and dose(s) NA | 60 Gy total | “severe toxicity” | Yes (CT terminated) | DOD (16 mo pD) | Yes |
| Oksüzoğlu 200268 | 29 (7.5 mo pS) | F | - | No | Tongue (oral cavity primary) | No | - | Dose NA | Mucositis (severe), thrombocytopenia, neutropenia, pleural effusion, sepsis | Yes | DOD (9 mo pS) | - |
| Millen 199771 | 18 (1 mo pS) | F | - | Yes (9) | Buccal mucosa with extension into masseter and parotid (oral cavity primary) | No | - | Dose NA (palliative) | Eye “deterioration” | NA | DOD (3 mo pS) | - |
| Lustig 199573 | 32 (2 mo pS) | F | - | No | Submandibular mass (oral cavity primary) | No | - | 3.2 Gy total | Mucositis, local bleeding, progressive pancytopenia | Yes (RT terminated) | DOD (9 mo pS, 6 mo pRT) | - |
| Snow 199174 | 30 (8 mo pS) | F | - | No | Supraclavicular fossa and anterior neck (esophageal primary) | No | - | 32.5 Gy total (palliative) | Well tolerated | No | DOD (12 mo pD) | - |