Proceedings of the 29th Annual ASTRO Meeting 61

206

CAUSES OF FAILURE IN THE RADIATION THERAPY OF HEAD AND NECK CANCER

Gilbert H. Fletcher, M.D. and Lester J. Peters, M.D. Division of Radiotherapy, The University of Texas M.D. Anderson Hospital and Tumor Institute at Houston, Houston, Texas 77030

Causes of failure of radiation therapy will be reviewed and illustrated with examples from cancers of the head and neck region. The distinction is made between those causes of failure that can be minimized by optimal application of concepts and techniques readily available to all radiotherapists, those that are not amenable to any modification of radiotherapeutic technique, and those that are potentially remediable by new treatment strategies based on the radiobiological attributes of individual tumors.

207 MULTIDISCIPLINARY TREATMENT OF HEAD AND NECK CANCER WITH CHEMOTHERAPY: UPDATE 1987

John Ross Clark, M.D.

Division of Medicine, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA 02115

The use of chemotherapy with surgery or radiotherapy in the multidisciplinary treatment of patients with squamous cell carcinoma of the head and neck (SCCHN) remains a controversial, but highly promising approach for patients with advanced disease. Numerous trials have evaluated the impact of chemotherapy with surgery or radiotherapy in the management of patients with previously untreated, but potentially curable (MO) lesions. This course will review the biologic rationale for multidisciplinary treatment with induction, synchronous or adjuvant chemotherapy, and critically discuss recent protocol designs, end-results and therapeutic implica- tions.

Adjuvant chemotherapy has been re-evaluated as post-operative treatment for patients with resectable SCCHN in several recent Phase II studies. While the experience with post-radiation adjuvant chemotherapy was compli- cated by enhanced mucositis and poor patient compliance, attenuated regimens of adjuvant combination chemo- therapy and altered adjuvant schedules are better tolerated. The impact of adjuvant chemotherapy against per- sistent microscopic disease is presently being evaluated in a Phase III RTOG trial which utilizes these new approaches. Induction chemotherapy or synchronous chemotherapy with radiotherapy is a preferred investigative approach for patients with lesions that are either unresectable or resectable with a disabling surgical proce- dure. Such treatment may facilitate regression of macroscopic tumor, improve resectability, enhance local- regional control of disease, and for selected patients, obviate the need for surgical resection. Encouraging data from Phase II studies of induction or synchronous chemotherapy will be contrasted with the experience from randomized trials using a control group of patients treated with conventional surgery and/or radiotherapy.

Continued progress awaits the development of improved regimens of combination chemotherapy and of optimal multidisciplinary treatment schedules, and clarification of the need for surgery after a complete response to induction chemotherapy or synchronous chemotherapy and radiotherapy. The end-results from ongoing prospective randomized trials are anxiously awaited. Such studies should confirm the potential of chemotherapy as a third modality in the treatment of patients with advanced SCCHN and establish this disease as a model for the multi- disciplinary treatment of solid tumors.

208 F'EDIXJXICHOIXKIN'S

SarahS. Donaldson,

DISEXE, NCM-HOIXKIX'S

M.D.

L!@zXzMA,AND_

Department of 'Iherapeutic Radiology, Stanford University M&ical center, Stanford, California 94305

Leuloeiniaa ccounts for app~x.iJnately 30% of childhood malignancies, tile lymphma acxcunts for another 15% (non-Hodgkin's lyqhcana 8%, Hodgkin's disez~? 7%), or nearly half of all childhood cancers intotal.'Ihe biology and therapy of these malignancies is undczyoing rapid change. tis wu?xe surromarizesandreviewstheee changes.

In Hodgkin's disease current eqAasis is on cxre of the child with a minkm~ of sequelae. l%e contmversial issues such as clinicalversusptholcgic staging and role oflymphographyversus ccmplted-yare review4 as well as therapeutic options as a function of age, stage, andprqnc5ticvariables. Resultsofthe Eurqeanaswell as&nericanstudies ispresent&alongwithareviewof late effects~~children with lor?g-term follow up.