A Phase III Study of Postoperative Radiation Therapy (IMRT) +/- Cetuximab for Locally-Advanced Resected Head and Neck Cancer

Inclusion Criteria

DISEASE CHARACTERISTICS:

- Histologically confirmed squamous cell carcinoma (including variants, such as
verrucous carcinoma, spindle cell carcinoma, or carcinoma not otherwise specified) of
the head and neck, including the following subtypes:

- Oral cavity

- Oropharynx

- Larynx

- Clinical stage T1, N1-2, M0 OR T2-4a, N0-2, M0 disease based on the following
diagnostic workup within the past 8 weeks:

- General history and physical examination by a Radiation Oncologist and/or
Medical Oncologist

- Chest x-ray or chest CT scan (with or without contrast) or chest CT/PET scan
(with or without contrast)

- Must have undergone gross total resection of the primary tumor with curative intent
within the past 7 weeks with surgical pathology demonstrating ≥ 1 of the following
criteria for "intermediate" risk of recurrence:

- Perineural invasion

- Lymphovascular invasion

- Single lymph node > 3 cm or ≥ 2 lymph nodes (all < 6 cm) (no extracapsular
extension)

- Close margin(s) of resection, defined as cancer extending to within 5 mm of a
surgical margin, and/or an initially focally positive margin that is
subsequently superseded by intraoperative negative margins (similarly, patients
whose tumors had focally positive margins in the main specimen but negative
margins from re-excised samples in the region of the positive margin are
eligible)

- Pathologically confirmed T3 or T4a primary tumor

- T2 oral cavity cancer with > 5 mm depth of invasion

- No positive margin(s) (defined as tumor present at the cut or inked edge of the
tumor), nodal extracapsular extension, and/or gross residual disease after surgery

PATIENT CHARACTERISTICS:

- Zubrod performance status 0-1

- Absolute granulocyte count ≥ 1,500/mm³

- Platelet count ≥ 100,000/mm³

- Hemoglobin ≥ 8.0 g/dL (transfusion or other intervention allowed)

- Total bilirubin < 2 times upper limit of normal (ULN)

- Aspartate aminotransferase (AST) or alanine aminotransferase (ALT) < 3 times ULN

- Serum creatinine < 2 times ULN OR creatinine clearance ≥ 50 mL/min

- Not pregnant or nursing

- Negative pregnancy test

- Fertile patients must use effective contraception

- No other invasive malignancy within the past 3 years, except for nonmelanomatous skin
cancer or previously treated carcinoma in situ of the breast, oral cavity, or cervix

- No simultaneous primary or bilateral tumors

- No severe, active co-morbidity, including any of the following:

- Unstable angina and/or congestive heart failure requiring hospitalization within
the past 6 months

- Transmural myocardial infarction within the past 6 months

- Acute bacterial or fungal infection requiring IV antibiotics at the time of
study registration

- Chronic obstructive pulmonary disease exacerbation or other respiratory illness
requiring hospitalization or precluding study therapy

- Idiopathic pulmonary fibrosis or other severe interstitial lung disease that
requires oxygen therapy or is thought to have required oxygen therapy within the
past year

- Hepatic insufficiency resulting in clinical jaundice and/or coagulation defects

- AIDS based on current Centers for Disease Control (CDC) definition

- Grade 3-4 electrolyte abnormalities according to CTCAE, v. 4, including any of
the following:

- Serum calcium (ionized or adjusted for albumin) < 7 mg/dL or > 12.5 mg/dL*

- Glucose < 40 mg/dL or > 250 mg/dL

- Magnesium < 0.9 mg/dL or > 3 mg/dL*

- Potassium < 3.5 mmol/L or > 6 mmol/L*

- Sodium < 130 mmol/L or > 155 mmol/L* NOTE: *Despite intervention to
normalize levels.

- No prior allergic reaction to cetuximab

PRIOR CONCURRENT THERAPY:

- See Disease Characteristics

- No prior systemic chemotherapy or anti-epidermal growth factor (EGF) therapy for this
cancer

- Prior chemotherapy or anti-EGF therapy for a different cancer allowed

- No prior radiotherapy to the region of the study cancer that would result in overlap
of radiotherapy fields

- No concurrent amifostine as a radioprotector

- No concurrent granulocyte colony-stimulating factor or erythropoietin