Abstract:Purpose/Objective: Inoperable local tumor recurrences in pre-irradiated areas of the head and neck pose a difficult therapeutic problem. The effect of re-irradiation was analysed in a prospective phase II study. Materials/Methods: Since 1995 recurrent head and neck carcinomas are uniformly treated at our department. The protocol consists in several courses of a combined radiochemotherapy: Each course is constituted by one week of treatment (2 Gy and 1.5 g HU / 300 mg/m2 5-FU i.v. bolus per day), followed by a one week break. Courses are repeated until a cumulative total dose of 120 Gy is reached. Toxicities are prospectively recorded using a standardized RTOG-compatible form. Results: Until 7/2002, 55 patients have been treated. The pretherapeutic performance status (WHO) was in 20 % grade 0, in 61 % grade 1 and in 19 % grade 2. Radiation dose usually amounted to 40 or 50 Gy with a median PTV volume of 310 cm3. In 8 cases, treatment was discontinued because of worsened general condition or disease progression. Acute toxicities grade 2 (3) were found for dermatitis in 36% (3%), mucositis in 35% (4%), and hematologic in 27% (6%). 3 months after treatment, 40% of patients reached a remission, which persisted for a median duration of 6 months. The median survival time amounted to 10 months, 4 patients currently have a survival time of > 36 months. Performance status, radiation dose, disease-free interval and pretreatment hemoglobin had a significant influence on survival. Late toxicities grade 1-2 (3) were observed in 22% (18%) of patients (mostly lymphedema and fibrosis). Conclusions: The reported protocol presents a treatment option with moderate toxicity, improved tumor regression and median survival than chemotherapy alone and, in individual cases, possible long term survival.
Schaefer MD, U,
The Effect of Re-irradiation of Inoperable Local Tumor Recurrences in Preirradiated Areas of the Head and Neck. Radiological Society of North America 2003 Scientific Assembly and Annual Meeting, November 30 - December 5, 2003 ,Chicago IL.
http://archive.rsna.org/2003/3240327.html