The epidermal growth factor receptor (EGFR) is a validated target in squamous cell carcinoma of the head and neck (HNSCC). However, despite high expression of EGFR in these cancers, EGFR inhibitor monotherapy has only had modest activity. Potential mechanisms of resistance to EGFR-targeted therapies involve EGFR and Ras mutations, epithelial-mesenchymal transition, and activation of alternative and downstream pathways. Strategies to optimize EGFR-targeted therapy in head and neck cancer involve not only the selection for patients most likely to benefit but also the use of combination therapies to target the network of pathways involved in tumor growth, invasion, angiogenesis, and metastasis. Clin Cancer Res; 16(9); 2489-95. ©2010 AACR.

BACKGROUND. In this retrospective study, the authors hypothesized that magnetic resonance imaging (MRI) would alter partial breast irradiation (PBI) eligibility by identifying cancers outside the PBI volume compared with mammography alone. METHODS. Since 2002, MRI was used nonselectively at the authors' institution for the staging of patients with nonmetastatic breast cancer. Of 450 consecutive patients with invasive breast cancer, 110 patients who were eligible for PBI were identified by using criteria outlined by National Surgical Adjuvant Breast and Bowel Project B‐39/Radiation Oncology Group trial 0413 based on mammography, ultrasonography, and initial pathology. In that trial, patients were randomized (stage I/II invasive cancers that measured ≤3 cm and ≤3 positive lymph nodes) to receive either whole‐breast radiotherapy or PBI. MRI reports were reviewed to determine whether MRI identified secondary lesions 1) within the same quadrant (multifocal), 2) in a different quadrant (multicentric), or 3) in the contralateral breast. These lesions were pathologically proven carcinoma and would have rendered the patient ineligible for PBI. RESULTS. MRI identified secondary lesions in 10% of patients (95% confidence interval [CI], 4.4%‐15.6%). Multifocal disease was identified in 3.6% (95% CI, 1.4%‐9%), multicentric disease was identified in 4.5% (95% CI, 2%‐10.2%), and contralateral disease was identified in 1.8% (95% CI, 0.5%‐6.4%). The proportion of patients with false‐positive MRI findings was 4.5% (95% CI, 2%‐10.2%). The positive predictive value of MRI was 72.2% (95% CI, 46.4%‐89.3%). CONCLUSIONS. MRI identified frequent secondary cancers that would not be removed routinely by surgery or targeted in the radiation field if treated with PBI. The current data suggest that MRI should be considered to assess PBI eligibility to minimize potential local failures. Cancer 2008. © 2008 American Cancer Society.

Incidence of oropharyngeal tumors has risen in both nH black and white males. However, nH white males have higher incidence of HPV, and nH black males have higher incidence of more aggressive and advanced HNSCCs. Racial differences in clinical characteristics associated with poorer survival exist, and future studies should determine factors associated with these differences.

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