Reirradiation alternating with docetaxel and cisplatin in inoperable recurrence of head-and-neck cancer: A prospective phase I/II trial
- Department of Radiation Oncology, Eberhard-Karls University, Tuebingen (Germany)
- Department of Radiology, Eberhard-Karls University, Tuebingen (Germany)
- Department of Head and Neck Surgery, Eberhard-Karls University, Tuebingen (Germany)
Purpose: Inoperable locoregional recurrences of head-and-neck cancer in a previously irradiated volume represent a therapeutic dilemma. Chemotherapy alone has no curative potential, whereas reirradiation and concurrent chemoradiation can salvage a small fraction of patients. Mucosal toxicity of concurrent chemoradiation requires substantial dose reduction of chemotherapy. Alternating chemoradiation offers the chance to give both full-dose chemotherapy and radiotherapy. The latter may provide a particular advantage for recurrent, potentially radiation resistant tumors. The feasibility and efficacy of a full-dose docetaxel containing alternating chemoradiation schedule was tested. Patients and Methods: Twenty-seven patients (Karnofsky performance status score {>=}70%) with histologically proven recurrent squamous cell cancer that occurred {>=} 6 months in a previously irradiated area ({>=} 60 Gy) were considered unresectable and unsuitable for brachytherapy. Alternating chemoradiation consisted of 3 cycles of docetaxel 60 mg/m{sup 2} d1 and cisplatin 15 mg/m{sup 2} d2-5, q d22, and involved field radiotherapy 2.0 Gy every day d8-12, d15-19, d29-33, and d36-40 (40.0 Gy total dose). Dose reduction of docetaxel to 50 mg/m{sup 2} was necessary, because of hematologic toxicity in the first 12 patients. Results: Alternating chemoreirradiation was applied as planned in 12 of 27 patients, with reirradiation completed per protocol in 81%. Overall, patients received 83% of the intended dose of docetaxel and 73% of cisplatin. Third-degree common toxicity criteria mucositis occurred in 15%, leukopenia of {>=} third degree by common toxicity criteria in 37%, and 3 early deaths were observed. Median time to follow-up, time to local progression, median survival, and 3-year survival rates were 42 months, 10 months, 10 months, and 18%, respectively. Conclusions: Alternating chemoreirradiation in recurrences of head-and-neck cancer resulted in 80% overall response with acceptable toxicity. A significant minority of patients had durable tumor control with a chance of long-term survival.
- OSTI ID:
- 20696176
- Journal Information:
- International Journal of Radiation Oncology, Biology and Physics, Vol. 61, Issue 5; Other Information: DOI: 10.1016/j.ijrobp.2004.08.020; PII: S0360-3016(04)02270-9; Copyright (c) 2005 Elsevier Science B.V., Amsterdam, Netherlands, All rights reserved; Country of input: International Atomic Energy Agency (IAEA); ISSN 0360-3016
- Country of Publication:
- United States
- Language:
- English
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