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Title: Long-term outcome of concurrent chemotherapy and reirradiation for recurrent and second primary head-and-neck squamous cell carcinoma

Abstract

Purpose: To define favorable pretreatment characteristics for overall survival (OS), progression-free survival (PFS), locoregional control, and freedom from distant metastasis for patients with recurrent and second primary head-and-neck cancer treated with concomitant chemotherapy and reirradiation. Methods and Materials: Our study population comprised a subset of 115 previously irradiated patients without overt metastases from 304 poor-prognosis head-and-neck cancer patients treated in seven consecutive phase I-II protocols. Of the 115 patients, 49, who had undergone surgical resection, were treated with a median of four cycles of concurrent chemotherapy and reirradiation and 66, who had not undergone surgical resection, were treated with a median of five cycles. The following regimens were used: 5-fluorouracil and hydroxyurea concurrent with reirradiation (FHX) (n = 14), cisplatin plus FHX (n = 23), paclitaxel plus FHX (n = 42), gemcitabine plus paclitaxel and 5-fluorouracil concurrent with reirradiation (n = 26), and irinotecan plus FHX (n = 10). Results: The median lifetime radiation dose was 131 Gy. The median follow-up for surviving patients was 67.4 months (range, 18.5-158.7). The median OS and PFS was 11 and 7 months (range, 0.2-158.7), respectively. The 3-year OS, PFS, locoregional control, and freedom from distant metastasis rate was 22%, 33%, 51%, and 61%,more » respectively. Multivariate analysis identified reirradiation dose, triple agent (cisplatin-, paclitaxel-, or gemcitabine-containing chemotherapy), and surgery before protocol treatment as independently prognostic for OS, PFS, and locoregional control. Triple-agent chemotherapy was prognostic for freedom from distant metastasis. Nineteen patients died of treatment-related toxicity, five of these of carotid hemorrhage. Conclusion: For recurrent and second primary head-and-neck cancer, trimodality therapy with surgery, concurrent chemotherapy, and reirradiation for a full second dose offers potential for long-term survival. Owing to the substantial toxicity and lack of an optimal regimen, reirradiation of recurrent head-and-neck cancer should be limited to clinical trials.« less

Authors:
 [1];  [1];  [2];  [2];  [1];  [1];  [1];  [3];  [2];  [1];  [4]
  1. Department of Radiation and Cellular Oncology, University of Chicago Pritzker School of Medicine, Chicago, IL (United States)
  2. (United States)
  3. Cancer Research Center, University of Chicago Pritzker School of Medicine, Chicago, IL (United States)
  4. Department of Radiation and Cellular Oncology, University of Chicago Pritzker School of Medicine, Chicago, IL (United States) and Cancer Research Center, University of Chicago Pritzker School of Medicine, Chicago, IL (United States). E-mail: dharaf@radonc.uchicago.edu
Publication Date:
OSTI Identifier:
20793294
Resource Type:
Journal Article
Resource Relation:
Journal Name: International Journal of Radiation Oncology, Biology and Physics; Journal Volume: 64; Journal Issue: 2; Other Information: DOI: 10.1016/j.ijrobp.2005.07.005; PII: S0360-3016(05)01165-X; Copyright (c) 2006 Elsevier Science B.V., Amsterdam, Netherlands, All rights reserved; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; CARCINOMAS; CHEMOTHERAPY; CLINICAL TRIALS; COMBINED THERAPY; HEAD; HEMORRHAGE; HYDROXYUREA; METASTASES; NECK; PATIENTS; RADIATION DOSES; SURGERY; TOXICITY; URACILS

Citation Formats

Salama, Joseph K., Vokes, Everett E., Section of Hematology/Oncology, University of Chicago Pritzker School of Medicine, Chicago, IL, Cancer Research Center, University of Chicago Pritzker School of Medicine, Chicago, IL, Chmura, Steven J., Milano, Michael T., Kao, Johnny, Stenson, Kirsten M., Section of Otolaryngology/Head and Neck Surgery, University of Chicago Pritzker School of Medicine, Chicago, IL, Witt, Mary Ellyn R.N., and Haraf, Daniel J.. Long-term outcome of concurrent chemotherapy and reirradiation for recurrent and second primary head-and-neck squamous cell carcinoma. United States: N. p., 2006. Web. doi:10.1016/J.IJROBP.2005.0.
Salama, Joseph K., Vokes, Everett E., Section of Hematology/Oncology, University of Chicago Pritzker School of Medicine, Chicago, IL, Cancer Research Center, University of Chicago Pritzker School of Medicine, Chicago, IL, Chmura, Steven J., Milano, Michael T., Kao, Johnny, Stenson, Kirsten M., Section of Otolaryngology/Head and Neck Surgery, University of Chicago Pritzker School of Medicine, Chicago, IL, Witt, Mary Ellyn R.N., & Haraf, Daniel J.. Long-term outcome of concurrent chemotherapy and reirradiation for recurrent and second primary head-and-neck squamous cell carcinoma. United States. doi:10.1016/J.IJROBP.2005.0.
Salama, Joseph K., Vokes, Everett E., Section of Hematology/Oncology, University of Chicago Pritzker School of Medicine, Chicago, IL, Cancer Research Center, University of Chicago Pritzker School of Medicine, Chicago, IL, Chmura, Steven J., Milano, Michael T., Kao, Johnny, Stenson, Kirsten M., Section of Otolaryngology/Head and Neck Surgery, University of Chicago Pritzker School of Medicine, Chicago, IL, Witt, Mary Ellyn R.N., and Haraf, Daniel J.. Wed . "Long-term outcome of concurrent chemotherapy and reirradiation for recurrent and second primary head-and-neck squamous cell carcinoma". United States. doi:10.1016/J.IJROBP.2005.0.
@article{osti_20793294,
title = {Long-term outcome of concurrent chemotherapy and reirradiation for recurrent and second primary head-and-neck squamous cell carcinoma},
author = {Salama, Joseph K. and Vokes, Everett E. and Section of Hematology/Oncology, University of Chicago Pritzker School of Medicine, Chicago, IL and Cancer Research Center, University of Chicago Pritzker School of Medicine, Chicago, IL and Chmura, Steven J. and Milano, Michael T. and Kao, Johnny and Stenson, Kirsten M. and Section of Otolaryngology/Head and Neck Surgery, University of Chicago Pritzker School of Medicine, Chicago, IL and Witt, Mary Ellyn R.N. and Haraf, Daniel J.},
abstractNote = {Purpose: To define favorable pretreatment characteristics for overall survival (OS), progression-free survival (PFS), locoregional control, and freedom from distant metastasis for patients with recurrent and second primary head-and-neck cancer treated with concomitant chemotherapy and reirradiation. Methods and Materials: Our study population comprised a subset of 115 previously irradiated patients without overt metastases from 304 poor-prognosis head-and-neck cancer patients treated in seven consecutive phase I-II protocols. Of the 115 patients, 49, who had undergone surgical resection, were treated with a median of four cycles of concurrent chemotherapy and reirradiation and 66, who had not undergone surgical resection, were treated with a median of five cycles. The following regimens were used: 5-fluorouracil and hydroxyurea concurrent with reirradiation (FHX) (n = 14), cisplatin plus FHX (n = 23), paclitaxel plus FHX (n = 42), gemcitabine plus paclitaxel and 5-fluorouracil concurrent with reirradiation (n = 26), and irinotecan plus FHX (n = 10). Results: The median lifetime radiation dose was 131 Gy. The median follow-up for surviving patients was 67.4 months (range, 18.5-158.7). The median OS and PFS was 11 and 7 months (range, 0.2-158.7), respectively. The 3-year OS, PFS, locoregional control, and freedom from distant metastasis rate was 22%, 33%, 51%, and 61%, respectively. Multivariate analysis identified reirradiation dose, triple agent (cisplatin-, paclitaxel-, or gemcitabine-containing chemotherapy), and surgery before protocol treatment as independently prognostic for OS, PFS, and locoregional control. Triple-agent chemotherapy was prognostic for freedom from distant metastasis. Nineteen patients died of treatment-related toxicity, five of these of carotid hemorrhage. Conclusion: For recurrent and second primary head-and-neck cancer, trimodality therapy with surgery, concurrent chemotherapy, and reirradiation for a full second dose offers potential for long-term survival. Owing to the substantial toxicity and lack of an optimal regimen, reirradiation of recurrent head-and-neck cancer should be limited to clinical trials.},
doi = {10.1016/J.IJROBP.2005.0},
journal = {International Journal of Radiation Oncology, Biology and Physics},
number = 2,
volume = 64,
place = {United States},
year = {Wed Feb 01 00:00:00 EST 2006},
month = {Wed Feb 01 00:00:00 EST 2006}
}