SAFETY AND EFFICACY OF CONCURRENT RADIOTHERAPY AND CETUXIMAB CHEMOTHERAPY VS RADIOTHERAPY ALONE FOR AGGRESSIVE SQUAMOUS CELL SKIN CANCER OF THE HEAD AND NECK

Abstract

Background: Aggressive squamous cell carcinoma (SCC) of the head and neck presents a therapeutic challenge due to its high recurrence and progression rates. While radiotherapy is a standard postoperative treatment, the addition of concurrent chemotherapy may enhance outcomes by improving locoregional control and overall survival. Cetuximab, an epidermal growth factor receptor (EGFR) inhibitor, has demonstrated efficacy in enhancing the therapeutic response in head and neck cancers. Objective: To compare the efficacy and safety of concurrent radiotherapy and cetuximab chemotherapy with radiotherapy alone in the treatment of aggressive squamous cell carcinoma of the head and neck. Study Design: Retrospective comparative study. Setting: Oncology Department, Nishtar Hospital, Multan, Pakistan. Duration of Study: February 2023 to February 2025. Methods: A total of 200 adult patients with histologically confirmed aggressive head and neck squamous cell carcinoma who underwent surgical resection were included through consecutive sampling. Patients were divided into two groups: Group A (n=100) received concurrent radiotherapy (average dose: 60 Gy in 2–2.25 Gy fractions) and cetuximab chemotherapy (400 mg/m² initial dose followed by 250 mg/m² weekly), and Group B (n=100) received radiotherapy alone. Key outcomes included local and metastatic recurrence rates, progression-free survival (PFS), overall survival (OS), and treatment-related adverse events. Statistical analysis was performed using chi-square and t-tests, with p < 0.05 considered statistically significant. Results: Local Non-Recurrence Rates: 1-year: 92% (Group A) vs. 94% (Group B); 2-year: 84% vs. 75%. Metastatic Non-Recurrence Rates: 1-year: 98% vs. 100%; 2-year: 94% vs. 89%. Progression-Free Survival: 1-year: 85% vs. 76%; 2-year: 73% vs. 55%. Overall Survival: 1-year: 99% (Group A) vs. 80% (Group B); 2-year: 79% vs. 74%. Adverse Events: Grade 3 dermatitis occurred in 15% of Group A and 30% of Group B patients. Conclusion: Concurrent radiotherapy with cetuximab chemotherapy demonstrated improved 2-year progression-free and overall survival in patients with aggressive head and neck squamous cell carcinoma compared to radiotherapy alone, with an acceptable safety profile. These findings support the use of combined modality treatment for better clinical outcomes.