Recurrent head and neck cancer: retreatment of previously irradiated areas with combined chemotherapy and radiation therapy-results of a prospective study.
OBJECTIVE
To prospectively test the effectiveness of combined chemotherapy and radiation therapy for recurrent head and neck cancer.


METHODS
In 32 patients, external-beam radiation therapy (2 Gy/d) was administered as a 5-day course with simultaneous hydroxyurea (1.5 g/d orally) and 5-fluorouracil (300 mg/m(2)/d bolus), followed by 9 days of rest. This cycle was repeated until a cumulative soft-tissue radiation dose of 110 Gy (including prior radiation therapy) was reached.


RESULTS
At a median follow-up of 18 months, three patients were alive, and 29 had died. The overall 1-year survival rate was 39%. The overall response rate was 41% (13 patients). Acute toxicity was low. According to World Health Organization and Radiation Therapy Oncology Group criteria, there were three cases of grade 3 mucositis or dermatitis and three cases of grade 3 or 4 neutropenia. Three patients had grade 3 late effects: one oral trismus, one jugular venous thrombosis, and one cerebral stroke.


CONCLUSIONS
The combination of simultaneous 5-fluorouracil and hydroxyurea infusion and local reirradiation is feasible for retreatment of recurrent head and neck tumors. This regimen provides short-term tumor control in most patients and long-term control in a few patients.
Department of Radiation Oncology, Westfaelische Wilhelms University, Medical Center, Albert-Schweitzer-Strasse 33, D-48129 Muenster, Germany. uschafe@uni-muenster.de
U
U
Schaefer
O
O
Micke
P
P
Schueller
N
N
Willich
D000368:Aged; D000964:Antimetabolites, Antineoplastic / Q000008:administration & dosage; D000970:Antineoplastic Agents / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D003872:Dermatitis / Q000209:etiology; D003875:Drug Eruptions / Q000209:etiology; D005240:Feasibility Studies; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000188:drug therapy / Q000532:radiotherapy*; D006801:Humans; D006918:Hydroxyurea / Q000008:administration & dosage; D007601:Jugular Veins; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D009092:Mucous Membrane / Q000187:drug effects / Q000528:radiation effects; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy / Q000532:radiotherapy*; D011446:Prospective Studies; D011879:Radiotherapy Dosage; D012074:Remission Induction; D019233:Retreatment; D020521:Stroke / Q000209:etiology; D015996:Survival Rate; D014313:Trismus / Q000209:etiology; D020246:Venous Thrombosis / Q000209:etiology
D000964:Antimetabolites, Antineoplastic; D000970:Antineoplastic Agents; D005472:Fluorouracil; D006918:Hydroxyurea