Chemotherapy and re-irradiation are safe and effective after salvage surgery in head and neck cancer

A French randomised trial shows that the combination of 5 FU and hydroxyurea used after surgery for patients who have recurred after radical radiotherapy, is safe and effective in improving progression free survival.This prospective, multicentre, randomised study aimed to assess the efficacy of full dose re-irradiation combined with chemotherapy after salvage surgery for head and neck cancer. It included 130 patients with head and neck cancer who were treated with salvage surgery and then randomly assigned either to full dose re-irradiation combined with chemotherapy (60 Gy in 12 weeks combined with concomitant 5FUand hydroxyurea, as in the Chicago regime, arm A) or observation only (arm B).To be eligible patients had to have a recurrence or second primary in an area previously irradiated to at least 45 Gy, no distant metastasis, salvage surgery with complete resection and be able to start adjuvant therapy within 6 weeks of surgery. There were 65 patients in each arm and these were well balanced for age, sex, tumour site, T and N re-staging, nodal involvement, extracapusular spread or positive margins. The main acute toxicity was Grade 3 and above mucositis in 29% of patients. The authors reported that late toxicity was also acceptable with a moderate increase in grade 3 or 4 trismus, mucosal atrophy and fibrosis in arm A. At a median follow up of three years, progression free survival was significantly improved in Arm A, but overall survival was not statistically different.The authors stated that this was the first randomised trial of full dose re-irradiation combined with chemotherapy after salvage surgery. Prepeared from abstract Reference...