Premium
Full dose reirradiation combined with chemotherapy after salvage surgery in head and neck carcinoma
Author(s) -
De Crevoisier Renaud,
Domenge Christian,
Wibault Pierre,
Koscielny Serge,
Lusinchi Antoine,
Janot François,
Bobin Serge,
Luboinski Bernard,
Eschwege François,
Bourhis Jean
Publication year - 2001
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/1097-0142(20010601)91:11<2071::aid-cncr1234>3.0.co;2-z
Subject(s) - medicine , mucositis , radiation therapy , osteoradionecrosis , surgery , lymph node , salvage therapy , chemotherapy
BACKGROUND The purpose of this study was to analyze the tolerance and efficacy of full dose reirradiation combined with chemotherapy in patients with head and neck carcinoma (HNC) with a high risk of recurrence after salvage surgery. METHODS Between 1991 and 1996, 25 patients having a recurrence or a second primary tumor in a previously irradiated area (> 45 grays [Gy]) were entered in this prospective study. All of them received salvage surgery and had a positive surgical margin and/or lymph node involvement with capsular rupture (N+R+). Adjuvant radiochemotherapy was given, delivering 60 Gy per 30 fractions with concomitant hydroxyurea and 5‐fluorouracil. The median total cumulative dose of the 2 irradiations was 118 Gy. The median follow‐up after the second irradiation was 66 months. RESULTS During the reirradiation course, Grade 3 and 4 mucositis were observed in 40% and 12%, respectively. Analysis of late effects (> 6 months after reirradiation) showed that 16% of the patients had osteoradionecrosis and 40% had Grade 2–3 cervical fibrosis (Radiation Therapy Oncology Group scoring system). The patterns of failure were as follows: local only (n = 9), lymph node only (n = 2), local and lymph node only (n = 1), and metastatic (n = 4). The 4‐year survival rate after reirradiation was 43% (95% confidence interval, 25–62). CONCLUSIONS Full dose reirradiation combined with chemotherapy after salvage surgery in high risk patients with HNC was feasible with an “acceptable” toxicity and led to a relatively good 5‐year survival rate. These results prompted the authors to initiate a multicentric randomized trial that is ongoing (GETTEC‐GORTEC 99‐01) to evaluate the benefit of adjuvant radiochemotherapy in these types of patients. Cancer 2001;91:2071–6. © 2001 American Cancer Society.