New Treatment Regimen Boosts Survival in Recurrent Head and Neck Cancer

quote:

A treatment regimen of re-irradiation, cisplatin and paclitaxel increases survival in recurrent head and neck cancer. Those findings were announced this week at the annual meeting of the American Society for Therapeutic Radiation and Oncology (ASTRO) in Denver, Colorado.

At this point, median follow-up is 23.6 months. The one-year survival rate is 50%, and 26% of patients have survived two years with this regimen, Dr. Horwitz reported. "Patients in the study were not candidates for surgery. These patients now have options where they really didn't before."

This message has been edited. Last edited by: Dr Vinod K Joshi,

Thanks Vinod for keeping us up to date with the latest publications. We would never see this info if you didn't 'post' it for us. I find it very interesting.
Thanks again
Sue

Hi Dr Joshi
Although the answer is now academic, I was interested to read about the re-irridation, they told Paul that they couldn't do it more than once, any idea why?

Hello Jennifer

Re-irradiation is new, experimental. Hence the short median follow-up of 23.6 months in the study above.

Best wishes
Vinod

My Dad has recurrent mouth/neck cancer. He was first diagnosed about 5-6 years ago and received radiology which damaged his speech, tongue and swallowing. Then 2 years later found a bump on the back of his neck. They removed that and we were hopeful it was all of it. Now they found cancer in his lungs and feel it is coming from the neck, based on a PET Scan. They say there is nothing they can do, but maybe some chemo but is there any clinical trials or new treatments for this type of situation?

Hello creed9630

Sorry I missed your post. The only new drug recently licenced is Erbitux. Hope things are okay with your Dad and that you are keeping well.

Best wishes
Vinod

Toxicity and survival outcomes of hyperfractionated split-course reirradiation and daily concurrent chemotherapy in locoregionally recurrent, previously irradiated head and neck cancers.
Watkins JM, Shirai KS, Wahlquist AE, Stuart RK, Chaudhary UB, Garrett-Mayer E, Day TA, Gillespie MB, Sharma AK.
Department of Radiation Oncology, Medical University of South Carolina, Charleston, South Carolina.
Head Neck. 2009 Jan 20. [Epub ahead of print]

quote:

BACKGROUND: Reirradiation of locoregionally recurrent, previously irradiated head/neck cancer may be considered in situations of unresectability, medical inoperability, or adverse pathologic features found at salvage resection.

METHODS: Retrospective cohort analysis of toxicity and survival outcomes in locoregionally recurrent, previously irradiated patients with head/neck cancer treated with hyperfractionated split-course radiotherapy and concurrent chemotherapy.

RESULTS: Between March 1998 and September 2006, 39 patients initiated reirradiation at median of 2.3 years (range, 0.5-19) following prior radiotherapy. At median survivor follow-up of 24.5 months (range, 3-63.9), 10 patients are alive without evidence of disease. Median survival is 19.0 months, with estimated 1-, 2-, and 3-year overall survivals of 60.1%, 45.1%, and 22.7%, respectively. Locoregional failure was the predominant site of postreirradiation recurrence. Male sex, total radiotherapy dose, cycles of chemotherapy completed, and clinical response were associated with improved overall survival.

CONCLUSIONS: Reirradiation can offer long-term survival for patients with recurrent, previously irradiated head/neck cancers.

(c) 2009 Wiley Periodicals, Inc. Head Neck, 2009.

This is good news, & gives us another tool to ask about, in case of reoccurence. Thank you or bringing this to our attention. Fran.

Dr Vinod ,Paul had the IMRT second time for recurrent findings but no chemo .Why do you think they did not add more chemo ,will ask at next appointment but was wondering ?
Thank you.

Bell.

Bell this might answer your question:

Reirradiation of recurrent head and neck cancers with curative intent.Chmura SJ, Milano MT, Haraf DJ.
Department of Radiation and Cellular Oncology, 5758 S. Maryland, MC 9006, Chicago, IL 60637, USA. schmura@radonc.uchicago.edu

In patients with recurrent, previously irradiated head and neck cancer, the traditional therapy of palliative single- or multi-agent chemotherapy yields a 30% to 40% response rate with median survival durations of 8 to 10 months. However, long-term survival is rarely observed. Reirradiation with or without concurrent chemotherapy is currently under investigation as a treatment option in these patients. While reirradiation without chemotherapy appears to be effective in recurrent nasopharynx cancer cases, the use of concomitant chemotherapy with reirradiation appears to offer improved outcomes based on phase I/II data in other head and neck sites. Recent studies indicate that long-term survival of patients is possible following reirradiation in a minority of cases despite severe acute and chronic toxicities. Reirradiation with chemotherapy is appropriate for patients with a goal of long-term local control of disease and curative intent, despite the risk of significant acute and late toxicities.

Thank you Cathy for this information was kind of you to take the time .We were back at hopital yesterday as Paul has had another nasty infection and the pong was just terrible so they have cleared and cleaned out his ear cavity again and sent off another swab so he is on a broad spectrum anti biotic at moment .

I asked about this question and was told because of Paul's previous history with the concurrent chemo and RT it was decided this was the appropriate action to take as they also felt the diagnosis of recurrence merited RT only .Not there exact words!! but that was the general interpretation.

Not sure if i feel comforted by this or a little concerned.

Thank you Cathy for taking the time to follow this up .Hope all is well with Chaz.I assume you are still waiting for scans and results.Thinking about you both .

Bell.

Bell,

So sorry that Paul is in the wars again and I hope his infection clears up soon. I thought the above abstract sounded pretty optimistic about irradiation for nasopharynx cancer so I shall keep my fingers crossed for you both.

I am really interested in these articlesas I am preparing myself for all possible scan outcomes and I must say your story and some of the abstracts above will be an additional source of optimism if we get bad news. I have already got our GP's support for second opinions at the Marsden etc should they be needed so feel I have done everything possible to be a good girl guide at this stage.

We were very relieved to have made the scan as the weather could have been against us, but I am so worried about the results - my stomache is already churning and we have another 5 days to go. Chaz's neck is suddenly looking swollen and he has had a cold for a few weeks which is causing me some anxiety. Like Paul he did not have surgery to remove the tumour, and that has also suddenly started to cause me huge amounts of angst.

Anyway, enough of the gloom. I had a lovely graduation day last week and am now a Dr. - we both enjoyed it enormously and we have had some great cinema outings this week so we are still managing to do lots of very enjoyable things.

Big hugs

Cathy

Hello Cathy, delighted you had a great time at your graduation you should be very proud of yourself .Try to relax a little about Chaz's scan ...thats good isn't it as I get the tummy churn as does everyone .Try not to worry about swelling in his neck this can be text book and expected after RT .If it poses a problem I can recomend the Lymphodoema massage Paul went for this and the Physio then gave me a hands on demo so I could continue this at home and I do every morning if possible .Paul's shirts at one point had to go up 2 sizes to accomodate his poor neck but has now gone down to normal size .

He also used to take weird swellings under chin and also face but this types of swelling was a skin infection underneath and a course of anti biotics cleared things up. There are so many different things appear as late as a year and over which are side effects and settle but do cause alarm .

At this moment in time 8 months from last RT we have hit some new snags as you know Paul is having a form of neuralgic pain in head and back of neck ,we have got that under control with Gabapentin and co-codomol at a dosage that he can cope with .

Meanwhile his poor ear ,this was the one that took the hit this time and is damaged it seems the inside of ear has folded in on itself so causng hearing loss and constant infections .It has flared up again and the ear and his nose is absolutely whiffy to the Nth degree.

He is also having a huge amount of nasal secretions that have changed and become clear so we went back to clinic and to be on safe side they are checking for a CSF leak but are fairly sure it will not be the case as so far they have not ever come accross this but becuase Paul tends to be the exception to the rule and had RT a second time they are going to check .That has been sent to Liverpool and may take a week or two.So waiting for swab results to come back and get correct antibiotic for his ear .

Meanwhile every time he coughs up phlegm there is quite a bit of blood so bit icky about this but I am putting it down to thorough scoping etc on Tuesday, waiting to hear about swab so will mention it then unless it gets worse .

Oh dear I have gone on some but sometimes when you off load someone else has been there and got some personal experience which helps .

Good to hear you are both out and about, any good films you would suggest we should go and see?

Love Bell .

Hi Bell

Sorry to hear about Paul's ear - do hope he gets it sorted out soon.

Hi Cathy

Hope Chaz's scan turns out OK - having to wait for results is always such a strain isn't it?
Have been meaning to ask for a while - what did you get your PhD in? Congratulations on your graduation - glad you both had a good time - a reward for all that hard work.

regards

Gwyn

My goodness Bell, you and Paul really have been having a tough time. How are both of your spirits? I would imagine Paul must be feeling quite down poor thing. I wonder whether his ear and nose problems fall under the huge umbrella of effects of 'acute toxicity' following a second round of radiation?

I have had some weird sinus and throat thing for years that means I frequently find blood in phlegm and have never really worried about it. I noted a conversation on the oral foundation which seemed to conclude that it quite a common phenomenon that need not be related to anything sinister so will keep my fingers crossed that it is nothing to worry about. I hope the swabs come back ok you seem to spend a great deal of time waiting for medical results. How is your daughter doing?

Chaz had a horrible night - I am certain he has hyponea as a result of his dewlap and at the moment he is consantly waking to clear his throat and nose. He coughed up some nasty goo this morning and I just hope its from his nose and not his lungs as he has an awful history of lung problems and when I went back to the report of the CT he had when he had breathing problems during treatment it shows that he not only as scarring as we were then informed, but that part of his right lung tissue has collapsed which they didnt talk about ..another thing to be worried about.

Anyway onto good cinema. We really enjoyed Milk and Frost/Nixon. Slumdog was lovely but a bit over rated I feel. I also thoroughly enjoyed Che part one and The Reader.

Thanks for your kind thoughts Gwyn - my PhD is in development studies - I was looking at the micro sociology of power relationships between international and local aid organizations in Cambodia. I met Chaz (through the internet) as a result of coming back to UK to when I started my PhD and he has been a wonderful support throughout the 5 year process. My biggest hope at the moment is that he will be well enough to do the Masters that he was meant to have started last September this year...it is the only real ambition I have at the moment.

Best wishes,
Cathy