title: Full dose reirradiation combined with chemotherapy after salvage surgery in head and neck carcinoma.
abstract: BACKGROUND
  The purpose of this study was to analyze the tolerance and efficacy of full dose reirradiation combined with chemotherapy in patients with head and neck carcinoma (HNC) with a high risk of recurrence after salvage surgery.
  
  
  METHODS
  Between 1991 and 1996, 25 patients having a recurrence or a second primary tumor in a previously irradiated area (> 45 grays [Gy]) were entered in this prospective study. All of them received salvage surgery and had a positive surgical margin and/or lymph node involvement with capsular rupture (N+R+). Adjuvant radiochemotherapy was given, delivering 60 Gy per 30 fractions with concomitant hydroxyurea and 5-fluorouracil. The median total cumulative dose of the 2 irradiations was 118 Gy. The median follow-up after the second irradiation was 66 months.
  
  
  RESULTS
  During the reirradiation course, Grade 3 and 4 mucositis were observed in 40% and 12%, respectively. Analysis of late effects (> 6 months after reirradiation) showed that 16% of the patients had osteoradionecrosis and 40% had Grade 2-3 cervical fibrosis (Radiation Therapy Oncology Group scoring system). The patterns of failure were as follows: local only (n = 9), lymph node only (n = 2), local and lymph node only (n = 1), and metastatic (n = 4). The 4-year survival rate after reirradiation was 43% (95% confidence interval, 25-62).
  
  
  CONCLUSIONS
  Full dose reirradiation combined with chemotherapy after salvage surgery in high risk patients with HNC was feasible with an "acceptable" toxicity and led to a relatively good 5-year survival rate. These results prompted the authors to initiate a multicentric randomized trial that is ongoing (GETTEC-GORTEC 99-01) to evaluate the benefit of adjuvant radiochemotherapy in these types of patients.
authors.affiliation: Département de Radiothérapie, Institut Gustave-Roussy, Villejuif, France.
authors.forename: R
authors.initials: R
authors.lastname: De Crevoisier
authors.forename: C
authors.initials: C
authors.lastname: Domenge
authors.forename: P
authors.initials: P
authors.lastname: Wibault
authors.forename: S
authors.initials: S
authors.lastname: Koscielny
authors.forename: A
authors.initials: A
authors.lastname: Lusinchi
authors.forename: F
authors.initials: F
authors.lastname: Janot
authors.forename: S
authors.initials: S
authors.lastname: Bobin
authors.forename: B
authors.initials: B
authors.lastname: Luboinski
authors.forename: F
authors.initials: F
authors.lastname: Eschwege
authors.forename: J
authors.initials: J
authors.lastname: Bourhis
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy* / Q000532:radiotherapy* / Q000601:surgery; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy* / Q000532:radiotherapy* / Q000601:surgery; D003131:Combined Modality Therapy; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006258:Head and Neck Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy* / Q000601:surgery; D006801:Humans; D006918:Hydroxyurea / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control; D011878:Radiotherapy / Q000009:adverse effects; D012307:Risk Factors; D016879:Salvage Therapy; D016019:Survival Analysis
chemical_list: D005472:Fluorouracil; D006918:Hydroxyurea