Concomitant chemotherapy and reirradiation as management for recurrent cancer of the head and neck

Thirty-five patients with inoperable recurrent head and neck cancer previou sly treated with definitive irradiation were treated with reirradiation and concomitant chemotherapy. Patient records were retrospectively reviewed to assess toxicity, response, and survival. Patients received one of three re gimens: 1) 40 Gy total (2 Gy daily), 300 mg/m(2) 5-fluorouracil intravenous bolus, and 2 g hydroxyurea orally daily for 5 days; 2) 48 Gy total (1.2 Gy twice daily), 300 mg/m2 5-fluorouracil intravenous bolus, and 1.5 g hydrox yurea orally daily for 5 days; 3) 60 Gy total (1.5 Gy twice daily), 300 mg/ m2 5-fluorouracil intravenous bolus, and 1.5 g hydroxy urea orally daily fo r 5 days. For all regimens, treatment was given only on weeks 1, 3, 5, and 7. Acute toxicity was mainly hematologic and was less severe with the lower hydroxyurea dose. Acute mucosal and skin toxicity was acceptable for all r egimens. Late toxicity was noted in 4 of 17 patients who survived 12 months or more. Late effects were Radiation Therapy Oncology Group grade 3 or les s. Fifteen of 35 patients achieved a complete response, and 11 of 35 patien ts achieved a partial response. The median survival rate was 10.5 months. T here was no significant difference in responses or median survival between the groups. Reirradiation of head and neck cancer with 5-fluorouracil and h ydroxyurea offers acceptable acute toxicity and minimal late effects. The c linical response rates and median survival are encouraging. Further investi gation is warranted.