RATIONALE: Drugs used in chemotherapy use different ways to stop tumor cells from dividing
so they stop growing or die. Radiation therapy uses high-energy x-rays to damage tumor
cells. Drugs such as amifostine may prevent the side effects of radiation therapy. Combining
more than one drug and combining radiation therapy and surgery with chemotherapy may kill
more tumor cells.
PURPOSE: Phase II trial to study the effectiveness of combining surgery, radiation therapy,
and combination chemotherapy in treating patients who have recurrent head and neck cancer
that has been treated previously with radiation therapy.
- Determine the effectiveness and toxic effects of intensive salvage therapy and
radiotherapy in previously irradiated patients with recurrent head and neck cancer.
- Determine the feasibility and effectiveness of amifostine at limiting or minimizing
side effects of repeat irradiation in these patients.
OUTLINE: Patients undergo surgical resection of gross disease (if not already done) followed
by 4-6 weeks of rest. Patients receive radiotherapy over 5 consecutive days on weeks 1, 2,
4, and 5. Intravenous cisplatin is administered on days 1-3 and 29-31. Intravenous
amifostine is administered 15-30 minutes prior to radiotherapy and cisplatin therapy.
Patients receive fluorouracil IV continuously on days 1-4 and 29-32.
Patients are followed every month for 1 year, every 2 months for 1 year, every 3 months for
1 year, every 4 months for 1 year, then every 6 months thereafter.
PROJECTED ACCRUAL: A total of 35 patients will be accrued for this study.
- Histologically confirmed recurrent or new primary squamous cell carcinoma of the head
and neck occurring in a previously irradiated field
- Pathologic stage of recurrence must be rT3-4 and/or rN2-3
- The following sites are eligible:
- Oral cavity, oropharynx, or hypopharynx: Any rT2-4 and/or clinical rN+
- Larynx: Any rT4, rT3 with perineural invasion, or any rT with clinical rN+
- Any site: Positive margin(s), at least 2 nodes or ECS
- No primary tumor of the nasopharynx
- Must be eligible for or have undergone complete resection which leaves behind no
gross residual disease
- Must have prior head and neck irradiation of 45-75 Gy
- Lifetime spinal cord radiotherapy dose no greater than 50 Gy
- No ongoing RTOG late morbidity of grade 3 or greater (unless correctable by surgery)
- No active acute radiation mucositis from previous radiotherapy
- 18 and over
- Karnofsky 70-100%
- Not specified
- WBC at least 4,000/mm^3
- Hemoglobin at least 9 g/dL (transfusion allowed)
- Platelet count at least 100,000/mm^3
- SGOT or SGPT no greater than 3 times upper limit of normal
- Bilirubin no greater than 2 mg/dL
- Creatinine no greater than 1.5 mg/dL
- No myocardial infarction, unstable angina, coronary heart failure, or uncontrolled
arrhythmias within past 6 months
- No severe cerebrovascular disease or hypotension not caused by antihypertensive
- Not pregnant
- Fertile patients must use effective contraception
- No allergy to cisplatin, fluorouracil, or amifostine
- No uncontrolled insulin-dependent diabetes mellitus or other medical condition
interfering with wound healing
PRIOR CONCURRENT THERAPY:
- Not specified
- No prior chemotherapy for tumor recurrence (except adjuvant chemotherapy)
- Not specified
- See Disease Characteristics
- At least 6 months since prior radiotherapy
- Prior radiotherapy treatment records must be available
- No prior salvage surgery consisting of partial laryngectomy