Reirradiation alternating with docetaxel and cisplatin in inoperable recurrence of head-and-neck cancer: A prospective phase I/II trial

Journal Article · Fri Apr 01 04:00:00 EST 2005 · International Journal of Radiation Oncology, Biology and Physics

DOI:https://doi.org/10.1016/j.ijrobp.2004.08.020· OSTI ID:20696176

Hehr, Thomas ^[1]; Classen, Johannes ^[1]; Belka, Claus ^[1]; Welz, Stefan ^[1]; Schaefer, Juergen ^[2]; Koitschev, Assen ^[3]; Bamberg, Michael ^[1]; Budach, Wilfried ^[1]

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1. Department of Radiation Oncology, Eberhard-Karls University, Tuebingen (Germany)
2. Department of Radiology, Eberhard-Karls University, Tuebingen (Germany)
3. 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, Journal Name: International Journal of Radiation Oncology, Biology and Physics Journal Issue: 5 Vol. 61; ISSN IOBPD3; ISSN 0360-3016
• Country of Publication: United States
• Language: English

Related Subjects

62 RADIOLOGY AND NUCLEAR MEDICINE
BRACHYTHERAPY
CARCINOMAS
CHEMOTHERAPY
HEAD
IRRADIATION
LEUKOPENIA
NECK
PATIENTS
PERFORMANCE
RADIATION DOSES
TOXICITY