Recurrent head and neck cancer: Retreatment of previously irradiated areaswith combined chemotherapy and radiation therapy - Results of a prospective study

PURPOSE: To prospectively test the effectiveness of combined chemotherapy a nd radiation therapy for recurrent head and neck cancer. MATERIALS AND METHODS: In 32 patients, external-beam radiation therapy (2 G y/d) was administered as a 5-day course with simultaneous hydroxyurea (1.5 g/d orally) and 5-fluorouracil (300 mg/m(2)/d bolus), followed by 9 days of rest. This cycle was repeated until a cumulative soft-tissue radiation dos e of 110 Cy (including prior radiation therapy) was reached. RESULTS: At a median follow-up of 18 months, three patients were alive, and 29 had died. The overall 1-year survival rate was 39%. The overall respons e rate was 41% (13 patients). Acute toxicity was low. According to World He alth Organization and Radiation Therapy Oncology Group criteria, there were three cases of grade 3 mucositis or dermatitis and three cases of grade 3 or 4 neutropenia. Three patients had grade 3 late effects: one oral trismus , one jugular venous thrombosis, and one cerebral stroke. CONCLUSION: The combination of simultaneous 5-fluorouracil and hydroxyurea infusion and local reirradiation is feasible for retreatment of recurrent h ead and neck tumors. This regimen provides short-term tumor control in most patients and long-term control in a few patients.