CONCURRENT CHEMORADIOTHERAPY FOR SALVAGE IN RELAPSED SQUAMOUS-CELL HEAD AND NECK-CANCER

The results in 9 patients with unresectable recurrent squamous cell ca ncer of the head and neck who were treated with aggressive concurrent chemoradiotherapy are reported. Treatment consisted of one or two cour ses of chemotherapy with 5-fluorouracil 1000 mg/m(2)/day and cisplatin 20 mg/m(2)/day, both given as 4-day continuous intravenous infusions, concurrent with radiation therapy. Salvage radiation doses between 30 and 70 Gy were administered. Seven patients had previously undergone an attempt at curative surgery, and 7 had been treated with radiation doses between 52 and 72 Gy. The recurrent disease was locally confined in 3, locoregional in 5, and locoregional with metastases in 1 of the 9 patients. Treatment toxicity was significant and included mucositis , nausea/vomiting, and granulocytopenia, but there were no toxic death s. Complete tumor clearance was possible in 6 of these 9 patients, and 5 patients remain disease-free at 41+, 43+, 45+, 47+, and 50+ months. Of these 5 patients, 4 had previously been treated with both surgery and radiation, while 1 had only undergone surgery. We conclude that ag gressive chemotherapy and concurrent (re)irradiation can be given to p atients with unresectable, recurrent, squamous cell cancer of the head adn neck. Treatment is tolerable, and disease-free long-term survival is possible. Careful patient selection, however is required.