[Cytoprotection with amifostine in the framework of radiochemotherapy in previously irradiated head and neck carcinoma].
OBJECTIVE
The radiotherapeutic possibilities are limited for patients with a recurrent or second head and neck cancer if the patient was already irradiated in the first therapy. In the presented study we investigated the changes of this situation due to the usage of amifostine in the case of re-irradiation (simultaneous radio-chemotherapy).


METHODS
Between 1995 and 1997 we treated 14 patients with a recurrent or second malignancy of the head and neck region by a simultaneous radio-chemotherapy (20 x 1.5 Gy, Carboplatin 70 mg/m2 BSA on days 1 to 5 and 16 to 20, 500 mg amifostine prior to every carboplatin infusion). Six out of 14 patients got an additional brachytherapy (10 to 15 Gy) to increase the local dose because of a residual tumor. In 4 cases the treatment was an adjunctive one, following the surgical tumor debulking.


RESULTS
We have seen 3 complete remissions (21.4%), and 8 partial remissions (57.1%). The median time of observation is 13 months now. Three out of 14 patients died, 2 because of the tumor. Hematological toxicities: side effects Grade 2 WHO were seen only in 1 patient. Acute non-hematological toxicities: mucositis Grade 0/1 in 7 patients, mucositis Grade 2 in 7 patients, dysphagia Grade 0/1 in 9 patients, dysphagia Grade 2 in 5 patients, xerostomia Grade 1 in 9 patients, xerostomia Grade 2 in 3 patients. We registrated only 1 serious late toxicity due to radio-chemotherapy: 4 months after brachytherapy a patient (with laryngectomy) developed a submental fistula.


CONCLUSIONS
These first results suggest that the usage of amifostine offers new potential ways for re-irradiation of patients with recurrent or second malignancies in the head neck region.
Büntzel
J
J
Klinik für Hals-Nasen-Ohren-Heilkunde, Plastische Operationen, Suhl. dr.buentzel@t-online.de
Glatzel
M
M
Schuth
J
J
Weinaug
R
R
Küttner
K
K
Fröhlich
D
D
D000328:Adult; D000368:Aged; D004999:Amifostine / Q000008:administration & dosage / Q000494:pharmacology*; D000740:Anemia / Q000209:etiology / Q000517:prevention & control; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D001918:Brachytherapy; D016190:Carboplatin / Q000008:administration & dosage / Q000627:therapeutic use; D003131:Combined Modality Therapy; D019610:Cytoprotection; D003680:Deglutition Disorders / Q000209:etiology / Q000517:prevention & control; D005260:Female; D006258:Head and Neck Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy* / Q000601:surgery; D006801:Humans; D007970:Leukopenia / Q000209:etiology / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy / Q000532:radiotherapy / Q000628:therapy*; D016609:Neoplasms, Second Primary / Q000188:drug therapy / Q000532:radiotherapy / Q000628:therapy*; D011182:Postoperative Care; D011837:Radiation-Protective Agents / Q000008:administration & dosage / Q000494:pharmacology*; D011878:Radiotherapy / Q000009:adverse effects; D011879:Radiotherapy Dosage; D013280:Stomatitis / Q000209:etiology / Q000517:prevention & control; D013921:Thrombocytopenia / Q000209:etiology / Q000517:prevention & control; D013997:Time Factors; D014987:Xerostomia / Q000209:etiology / Q000517:prevention & control
D000970:Antineoplastic Agents; D011837:Radiation-Protective Agents; D016190:Carboplatin; D004999:Amifostine
Zytoprotektion mit Amifostin im Rahmen der Radiochemotherapie bei vorbestrahlten Kopf-Hals-Karzinomen.