Toxicity and outcome analysis of patients with recurrent head and neck cancer treated with hyperfractionated split-course reirradiation and concurrent cisplatin and paclitaxel chemotherapy from two prospective phase I and II studies.
BACKGROUND
Patients with local recurrences or new head and neck primary tumors in previously irradiated tissues have few options for salvage treatment. One option for select patients is to undergo reirradiation with concurrent chemotherapy. The purpose of this study is to report the initial clinical results of the Fox Chase phase I and II prospective reirradiation and chemotherapy studies.


METHODS
Between July 1996 and January 2002, 38 patients with locally recurrent unresectable squamous cell carcinoma of the head and neck were treated with concurrent chemotherapy and reirradiation on two prospective trials. All patients had received prior radiation therapy to the head and neck region (median dose, 64.2 Gy). Patients received cisplatin and paclitaxel along with hyperfractionated external beam radiation therapy to the site of recurrence.


RESULTS
The median follow-up was 10 months. The median survival was 12.4 months, with actuarial rates of overall survival of 50% and 35% at 1 and 2 years, respectively. During follow-up, 63% of patients experienced local progression of disease, all in the irradiated field. Actuarial progression-free survival at 1 year was 33%, with a median time to progression of 7.3 months. Acute grade 3 to 4 toxicity included neutropenia, nausea, emesis, and mucositis.


CONCLUSIONS
Hyperfractionated split-course reirradiation and concurrent cisplatin and paclitaxel chemotherapy demonstrates durable locoregional control in select patients, although late toxicity may occasionally be significant. Only sites of disease recurrence need to be covered in the reirradiation fields.
Kramer
Noel M
NM
Department of Radiation Oncology, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, Pennsylvania 19111-2497, USA.
Horwitz
Eric M
EM
Cheng
Jonathan
J
Ridge
John A
JA
Feigenberg
Steven J
SJ
Cohen
Roger B
RB
Nicolaou
Nicos
N
Sherman
Eric J
EJ
Babb
James S
JS
Damsker
Jason A
JA
Langer
Corey J
CJ
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000628:therapy*; D002945:Cisplatin / Q000008:administration & dosage; D019583:Dose Fractionation, Radiation; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000401:mortality / Q000628:therapy*; D006801:Humans; D009325:Nausea / Q000209:etiology; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000628:therapy*; D009503:Neutropenia / Q000209:etiology; D017239:Paclitaxel / Q000008:administration & dosage; D011446:Prospective Studies; D019233:Retreatment; D016879:Salvage Therapy / Q000379:methods*; D013280:Stomatitis / Q000209:etiology; D014839:Vomiting / Q000209:etiology
D017239:Paclitaxel; D002945:Cisplatin