Allen

While a second course of radiation is not standard, here is the excerpt on it's growing use from the latest 13th edition of a textbook for doctors on oconology management
[quote]Surgery is the standard of care for the treatment of recurrent disease, but there is a growing body of
evidence suggesting that reirradiation with concurrent chemotherapy can cure selected patients when
resection is not possible. Several institutions have reported experiences retreating patients, and these
results led to the development of the first multi-institution reirradiation study.
After surgery for head and neck cancer, patients remain at high risk of locoregional recurrence. Having
undergone surgery for recurrent disease, 130 patients were randomized to receive postoperative
reirradiation combined with concomitant hydroxyurea and fluorouracil or undergo observation. A
higher incidence of treatment-related mortality and severe acute and chronic toxicity was found in the
treatment group. The disease-free, but not overall, survival was improved in the treatment arm (P =
.006 and .5, respectively) (Janot F et al: J Clin Oncol 26:5518�5523, 2008).
A single-arm, phase II study (RTOG 96-10) evaluated toxicity and therapeutic results for patients with
recurrent squamous cell carcinoma of the head and neck. Eighty-six patients received four weekly
courses of 1.5-Gy fractions twice daily with concurrent 5-FU and hydroxyurea. Each cycle was
separated by 1 week of rest. The median survival was 8.1 months, and the 1- and 2-year survival rates
were 41.7% and 16.2%, respectively. Compared with patients who experienced early recurrences,
patients whose disease recurred 3 years after the original irradiation fared better, with 1- and 2-year
survival rates of 48.1% and 32.1%, respectively.
The first results for the entire cohort of patients for RTOG 99-11, the successor trial to RTOG 96-10,
were presented in 2005. In this study, patients with locally recurrent or second primary head and neck
tumors, who previously received radiation therapy were treated with split-course hyperfractionated
radiotherapy (60 Gy total; 1.5 Gy/fraction twice daily for 5 days every 2 weeks for 4 cycles) in
combination with cisplatin (15 mg/m� IV daily) for 5 courses and paclitaxel (20 mg/m� IV daily) for 5
courses every 2 weeks for 4 cycles. Granulocyte colony-stimulating factor (G-CSF) support was
administered on days 6 through 13 of each 2-week cycle. Of the 105 patients enrolled, 99 were eligible
for analysis, and 23% of the patients had second primary head and neck tumors. The median prior dose of radiotherapy was 65.4 Gy (range: 45�75 Gy), and the median time from prior radiotherapy was 40 months.
Of eight patients with grade 5 (fatal) toxicities, five occurred during the acute period (dehydration,
pneumonitis, neutropenia [2 cases], and cerebrovascular accident) and three during the late period (two
of three attributable to carotid hemorrhage). Other acute toxicities included leukopenia (30% grade 3/4),
anemia (21% grade 3/4), and GI toxicity (48% grade 3/4). The median follow-up for patients was 23.6
months, and the median survival was 12.1 months.
The estimated 1- and 2-year overall survival rates were 50.2% and 25.9%, respectively. The median and
1-year progression-free survival rates were 7.8 months and 35%, respectively. Overall survival was
significantly better (P = .044) than for the historic control in RTOG 96-10 (estimated 1- and 2-year
overall survival rates 41.7% and 16.7%, respectively).
Despite significant toxicity and high mortality, hyperfractionated split-course reirradiation with
concurrent cisplatin and paclitaxel chemotherapy proved feasible in this select patient population. This
approach was to be tested in an RTOG 04-21, a phase III trial, which was to randomize patients between
this arm and chemotherapy alone; however, this trial was closed due to a lack of accrual in early 2007.
[/quote]
I just saw my ENT surgeon yesterday and she was very happy with my progress in recovering from a double dose of rad and chemo.
Charm