A Pilot Study of Combined Modality Therapy for Recurrent Head and Neck Carcinoma

Fecha de inicio: 1 de diciembre de 1998

DISEASE CHARACTERISTICS: 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 PATIENT CHARACTERISTICS: Age: 18 and over Performance status: Karnofsky 70-100% Life expectancy: Not specified Hematopoietic: WBC at least 4,000/mm^3 Hemoglobin at least 9 g/dL (transfusion allowed) Platelet count at least 100,000/mm^3 Hepatic: SGOT or SGPT no greater than 3 times upper limit of normal Bilirubin no greater than 2 mg/dL Renal: Creatinine no greater than 1.5 mg/dL Cardiovascular: 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 medication Other: 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: Biologic therapy: Not specified Chemotherapy: No prior chemotherapy for tumor recurrence (except adjuvant chemotherapy) Endocrine therapy: Not specified Radiotherapy: See Disease Characteristics At least 6 months since prior radiotherapy Prior radiotherapy treatment records must be available Surgery: No prior salvage surgery consisting of partial laryngectomy