Kenneth Hu

Phase I Trial of Gefitinib in Combination With Radiation or Chemoradiation for Patients With Locally Advanced Squamous Cell Head and Neck Cancer

PURPOSE To establish the safety and toxicity profile of daily gefitinib with radiation alone or with concurrent chemoradiotherapy in previously untreated patients with locally advanced squamous cell head and neck cancer (LAHNC). PATIENTS AND METHODS Patients with intermediate-stage LAHNC were treated with concomitant boost radiation (RT) alone with escalating doses of daily gefitinib (250 or 500 mg; cohort I). Once a safety profile was determined with RT alone, patients with high-risk disease were then treated with daily gefitinib (250 or 500 mg), weekly cisplatin (CDDP; 30 mg/m2), and once-daily RT (cohort II). Patients also received post-RT gefitinib at 250 mg daily for a period of up to 2 years. RESULTS Twenty-three patients were enrolled and assessable for toxicity. No dose-limiting toxicities (DLTs) were observed in patients treated in cohort I at either 250 or 500 mg of gefitinib daily with concomitant boost RT to 72 Gy. In patients receiving chemoradiotherapy and gefitinib (cohort II), DLTs included one grade 4 diarrhea and one grade 4 neutropenic fever. Fifteen patients started maintenance gefitinib, and eight (53%) experienced grade 1 to 2 acne-like skin rash and diarrhea, but no grade 3 or 4 toxicity occurred. CONCLUSION Gefitinib (250 or 500 mg daily) was well tolerated with concomitant boost RT or concurrent chemoradiotherapy with weekly CDDP. Protracted administration of gefitinib for up to 2 years at 250 mg daily was also tolerated well.

Intraoperative high-dose-rate radiotherapy in the management of locoregionally recurrent head and neck cancer†

The purpose of this article was to present the Beth Israel Medical Center experience using high‐dose‐rate intraoperative radiotherapy (HDR‐IORT) in the management of recurrent head and neck cancer.

Adjuvant radiation therapy of retroperitoneal sarcoma: the role of intraoperative radiotherapy (IORT)

Purpose. The purpose is to review the natural history, the clinicopathological prognostic factors, and the role of adjuvant radiation therapy with particular attention to the limited but favorable experience with IORT. Methods. Retroperitoneal sarcomas present a continuing therapeutic challenge to the oncologist. In contrast to sarcomas of the extremity and superficial trunk in which complete resection plus radiation therapy results in excellent local control, sarcomas of the retroperitoneum are difficult to resect and even if completely resected, demonstrate high rates of local relapse, the primary pattern of failure. Due to the proximity of normal organs, the delivery of therapeutic doses of adjuvant external beam radiation therapy is problematic.To deliver adequate doses (>60 Gy) of external beam to most patients would result in unacceptable toxicity. The therapeutic dilemma is unfortunate and better strategies are needed. One attractive approach has been to incorporate intraoperative radiation therapy (IORT) with maximal resection and external beam radiation. Results and Discussion. A number of institutions have explored this approach with encouraging preliminary results.

Treatment of Head and Neck Paragangliomas.

BACKGROUND Commonly occurring in the head and neck, paragangliomas are typically benign, highly vascular neoplasms embryologically originating from the extra-adrenal paraganglia of the neural crest. Frequently, these tumors are associated with the vagus or tympanic plexus nerve or the carotid artery, or jugular bulb. Their clinical presentation can vary across a wide spectrum of signs and symptoms. METHODS We reviewed and compared standard treatment approaches for paragangliomas of the head and neck. RESULTS In general, surgery is the first-line choice of therapy for carotid body tumors, whereas radiotherapy is the first-line option for jugular and vagal paragangliomas. CONCLUSIONS Because of the complexity of clinical scenarios and treatment options for paragangliomas, a multidisciplinary algorithmic approach should be used for treating paragangliomas. The approach should emphasize single-modality treatment that yields excellent rates of tumor control, low rates of severe, iatrogenic morbidity, and the preservation of long-term function in this patient population.

Patterns of care and outcomes of adjuvant therapy for high‐risk head and neck cancer after surgery

Postoperative chemoradiotherapy (CRT) is considered standard of care in patients with locally advanced head and neck cancer with positive margins and/or extracapsular extension (ECE).