title: Twice-daily reirradiation for recurrent and second primary head-and-neck cancer with gemcitabine, paclitaxel, and 5-fluorouracil chemotherapy.
abstract: OBJECTIVE
  We previously demonstrated the efficacy of concurrent gemcitabine, paclitaxel, and 5-fluorouracil in conjunction with twice-daily (1.5-Gy) radiotherapy delivered on alternating weeks (TFGX(2)) in locally advanced head-and-neck cancer. Here, we report the clinical outcome and late toxicity of TFGX(2) in a subset of patients previously irradiated to the head and neck.
  
  
  METHODS
  Twenty-nine previously irradiated patients, presenting with recurrent or second primary head-and-neck cancer, underwent TFGX(2). Twelve patients underwent attempted surgical resection before chemoradiotherapy, 10 of whom were left with no measurable disease. Patients with measurable disease received a median radiation dose of 72 Gy; those with no measurable disease received a median dose of 61 Gy. The cumulative dose ranged from 74.4 to 156.4 Gy (mean, 125.7 Gy; median, 131.0 Gy).
  
  
  RESULTS
  The median follow-up was 19.1 months (50.9 months for living patients). The 5-year overall survival rate was 34.5%, and the locoregional control rate was 54.5%. In patients with measurable disease at treatment, the 5-year overall survival and locoregional control rate was 26.3% and 45.1%, respectively, compared with 50.0% (p = 0.14) and 70% (p = 0.31), respectively, for those with no measurable disease. Measurable disease and radiation dose were highly statistically significant for overall survival and locoregional control on multivariate analysis. Of 14 patients assessable for late toxicity, 3 developed Grade 4-5, 8 Grade 2-3, and 3 Grade 0-1 toxicity.
  
  
  CONCLUSIONS
  Aggressive reirradiation with chemotherapy in locally advanced head-and-neck cancer provides a chance for long-term cure at the expense of toxicity. Attempted surgical resection before chemoradiotherapy improved disease control and survival.
authors.affiliation: Department of Radiation and Cellular Oncology, University of Chicago Pritzker School of Medicine, 5841 S. Maryland Ave., MC 9006, Chicago, IL 60637, USA. MTMilano@yahoo.com
authors.forename: Michael T
authors.initials: MT
authors.lastname: Milano
authors.forename: Everett E
authors.initials: EE
authors.lastname: Vokes
authors.forename: Joseph K
authors.initials: JK
authors.lastname: Salama
authors.forename: Kerstin M
authors.initials: KM
authors.lastname: Stenson
authors.forename: Johnny
authors.initials: J
authors.lastname: Kao
authors.forename: Mary-Ellyn
authors.initials: ME
authors.lastname: Witt
authors.forename: Bharat B
authors.initials: BB
authors.lastname: Mittal
authors.forename: Athanassios
authors.initials: A
authors.lastname: Argiris
authors.forename: Ralph R
authors.initials: RR
authors.lastname: Weichselbaum
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Haraf
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D000971:Antineoplastic Combined Chemotherapy Protocols; D003131:Combined Modality Therapy; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives*; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006258:Head and Neck Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy* / Q000532:radiotherapy*; D016609:Neoplasms, Second Primary / Q000188:drug therapy* / Q000532:radiotherapy*; D017239:Paclitaxel / Q000008:administration & dosage; D011879:Radiotherapy Dosage; D000093542:Gemcitabine
chemical_list: D003841:Deoxycytidine; D017239:Paclitaxel; D005472:Fluorouracil; D000093542:Gemcitabine