Re-irradiation with 36 Gy (1.5 Gy Twice Daily) Plus Paclitaxel for Advanced Recurrent and Previously Irradiated SCCHN is Feasible

Abstract

Abstract. Background About half the patients who were treated for advanced nonmetastatic squamous cell carcinoma of the head and neck (SCCHN) develop a loco-regional recurrence either at the primary tumor site and/or in regional lymph nodes (1-3). In case of such a recurrence, a complete resection is often not safely possible, and the patients are referred to radiotherapy, ideally combined with concurrent chemotherapy (4). However, many of these patients had already received 60-70 Gy of radiotherapy (usually with 5 daily fractions of 2 Gy per week) as part of their primary treatment, either as a definitive or an adjuvant approach. For the treatment of a loco-regional recurrence, the second course of radiotherapy cannot be safely administered with 60-70 Gy again when taking into account the tolerance doses of the organs at risk in the head and neck region (5). This problem may be partly overcome with the addition of concurrent chemotherapy, which can be assumed to represent more than additional 10% of the radiotherapy dose regarding the effect of tumor cell kill (6). Cisplatin and carboplatin are the most commonly used agents for SCCHN. However, many patients, particularly in recurrent disease after chemoradiation, may not be able to receive platin-based chemotherapy again due to expected toxicity such as nausea, vomiting and renal failure (7). For these patients, taxanes may be an alternative option, since these agents have been proved effective as a monotherapy in patients with SCCHN (8-10). In addition to concurrent chemotherapy, twice-daily administration of radiotherapy with lower doses per fraction (e.g. of 1.5 Gy) is a relatively novel approach to improve treatment outcome in such coditions. The risk of late radiation morbidity can be decreased with the use of lower doses per fraction (11). Normal tissues can recover from radiotherapy after 6 to 8 hours, whereas tumor cells generally do not recover. We followed this approach in a previous report of patients receiving mainly 30 Gy of radiotherapy with two daily fractions of 1.5 Gy supplemented by 20-25 mg/m 2 of paclitaxel administered twice weekly (12). However, the question arose whether a better outcome could be achieved with a higher radiation dose than 30 Gy. Therefore, we increased the total radiation dose to 36 Gy in the present series and investigated the feasibility and efficacy of this regimen. Patients and MethodsFour patients with head-and-neck cancer, two women and two men, underwent this therapy regimen. These patients had developed an advanced loco-regional recurrence of SCCHN following surgery plus postoperative platin-based chemoradiation. Two patients had oropharynx cancer, one patient cancer of the oral cavity and one 519

Advancements of radiotherapy for recurrent head and neck cancer in modern era

“…Toxicity didn’t exceed grade 2 [ 79 ]. Rades et al [ 80 , 81 ] reported that using lower dose ranging from 36 to 44.4 Gy concurrent with paclitaxel, four of 6 patients survived over 12 months after re-irradiation. Only 1/6 patient developed into grade 3 toxicity.…”