John M. Watkins MD, Presenter: Nothing to Disclose

Anand Kumar Sharma MD, Abstract Co-Author: Nothing to Disclose

Debajyoti Sinha PhD, Abstract Co-Author: Nothing to Disclose

Keisuke S. Shirai, Abstract Co-Author: Nothing to Disclose

M. Boyd Gillespie MD, Abstract Co-Author: Nothing to Disclose

Terry L. Day, Abstract Co-Author: Nothing to Disclose

Paul O'Brien, Abstract Co-Author: Nothing to Disclose

Describe toxicity and survival outcomes of cohort of HNCa patients treated with BID-SC ReRT and concurrent chemotherapy.

Departmental records were reviewed for patients with history of prior head/neck RT who underwent ReRT for HNCa in BID-SC fractionation with concurrent chemotherapy at MUSC. BID-SC was defined as twice-daily radiotherapy, delivered 5 days/week every other week, with chemotherapy given between fractions on radiotherapy days.

Between March 1998 and September 2006, 31 patients initiated BID-SC ReRT and concurrent chemotherapy for recurrent HNCa at a median of 2.5 years (range 0.5-12) following prior RT. Median age at recurrence was 57 years (range 39-76). Recurrent tumor site location was oropharynx in 52%, neck (23%), oral cavity (10%), larynx (10%), nasopharynx (3%), and hypopharynx (3%). Recurrence occurred within previously irradiated field in 58% of patients, at prior field edge (26%), and outside of prior field (16%). Recurrent clinical tumor stage was AJCC III-IVB in 74%. Salvage BID-SC chemoradiotherapy was definitive in 71% or post-operative (29%). Daily chemotherapy consisted of cisplatin/paclitaxel (15/20 mg/m2) in 81%, 5-fluorouracil/hydroxyurea (300/1500 mg/m2, 16%), and cisplatin (10 mg/m2, 3%). Four patients required hospitalization during therapy for a median of 12 days (range 8-19), all for neutropenic fever. Median weight loss was -2.6% of baseline (range -22.1% to +3.8%). At a median survivor follow-up of 12.3 months (range 2.4-64.4), 36% of patients are alive without evidence of disease, 3% alive with disease, 36% died of/with disease, 13% died of treatment-associated complications, and 13% died of other cause. Crude 1-, 2-, and 3-year overall survivals are 48%, 46%, and 10%, respectively. Pattern of failure for the 10 patients with recurrent disease were within the radiotherapy field in 5 patients, at field margin (2), regional out of field (2), and loco-regional plus distant (1).

ReRT with BID-SC fractionation and concurrent chemotherapy is well-tolerated and can offer opportunity for long-term survival for patients with recurrent HNCa.

ReRT can offer opportunity for salvage and survival from recurrent HNCa.

Watkins, J, Sharma, A, Sinha, D, Shirai, K, Gillespie, M, Day, T, O'Brien, P, Re-irradiation (ReRT) of Head and Neck Cancer (HNCa) Using Twice-Daily Split-Course Fractionation (BID-SC) with Concurrent Chemotherapy: The Medical University of South Carolina (MUSC) Experience.  Radiological Society of North America 2007 Scientific Assembly and Annual Meeting, November 25 - November 30, 2007 ,Chicago IL. http://archive.rsna.org/2007/5002427.html