Re-irradiation with concomitant chemotherapy of unresectable recurrent head and neck cancer: A potentially curable disease

Purpose: The purpose of this study was to review the outcome following concomitant chemoradiation therapy in previously irradiated patients with locally or regionally recurrent or persistent head and neck cancer considered unresectable for cure. Methods and materials: We identified 45 patients treated between 1986 and 1993 with unresectable locally or regionally recurrent disease who were treated on one of four concomitant chemoradiotherapy phase I/II studies at the University of Chicago. All patients received hydroxyurea (HU), 5-fluorouracil (5-FU) and concomitant radiation therapy on an alternate week schedule (FHX). Cisplatin was added to FHX in three of the studies. Results: The overall survival, progression-free survival, and local/regional control at 5 years was 14.6%, 13.5% and 20%, respectively, in a cohort of patients whose disease is almost universally fatal. Fatal treatment related complications were observed in 5 (11%) of patients. Two of these complications were related to radiation therapy. Stepwise Cox regression analysis revealed that dose and protocol were significantly correlated with survival, progression-free survival and local/regional control. A direct correlation was observed with radiation dose and an inverse correlation was observed with the initial FHX dose escalation study. The 2-year survival was 35% in patients receiving over 58 Gy compared to 8% for those receiving less than 58 Gy. Conclusions: Our results show that aggressive re-irradiation with concomitant chemotherapy of recurrent head and neck cancer results in the cure of some patients with acceptable toxicity if tumoricidal doses are applied. These results are in contrast to historical series of chemotherapy alone which results in limited palliation of brief duration and almost no chance of cure. Thus, re-irradiation with concomitant chemotherapy should be further investigated as an alternative to chemotherapy alone in multi-center or cooperative group randomized trials.