Re-irradiation combined with local hyperthermia of unresectable nodal recurrences of head and neck epidermoid carcinomas

From 1985 to 1989, we treated, in a phase II clinical trial, 50 isolated unresectable nodal recurrences of head and neck epidermoid carcinomas in previously irradiated fields. The median diameter of these nodes was 4.5 cm (3-6 cm). Local hyperthermia was achieved in all patients with a 13.56 MHz radio frequency capacity system. A hyperthermia session was carried out for 60 min just after each radiation treatment, twice a week. The median total number of sessions was 17 (10-20). Radiation therapy (electron beams) was administered with the aim of avoiding damage to previously irradiated tissues. The dose per fraction at the point of maximum dose was 4 Gy (the target dose at 90% depth was 3.6 Gy). The mean target total dose at 90% depth was 54 Gy (32-60). With this combined treatment, the overall response rate was 88% without toxicity. A local control (NED) was observed in 18/50 (36%) patients. The 2-year survival rate for this group was 27% (Kaplan Meier). The acute toxicity was mild in spite of the fact that these patients had previously received radiation treatment. The late reactions were not markedly exacerbated as compared to the initial situation. Radiation therapy combined with local hyperthermia seems to be a safe form of treatment for these unresectable and isolated nodal recurrences of head and neck carcinomas