Proceedings of the 39th Annual ASTRO Meeting 115

109 Chemotherapy for Head and Neck Cancer

David G. Pfister, M.D. Memorial Sloan-Kettering Cancer Center, New York, NY

Puroose/Obiective: The role of chemotherapy in the management of squamous cell carcinoma of the upper aerodigestive tract is undergoing rapid evolution. Historically, the use of chemotherapy was limited to patients with incurable disease who had exhausted all surgical and radiation therapy options. The results of recent randomized trials, however, suggest an increasing role for chemotherapy as part of primary management in patients with unresectable disease; advanced larynx OI hypopharynx cancer with the intent of larynx preservation, or advanced nasopharynx cancer. This refresher course will provide a comprehensive overview of the current indications for chemotherapy in the management of these malignancies, and will highlight areas of controversy and future directions of investigation. More specifically, the following areas will be emphasized.

1. The identification of drugs commonly used in the management of head and neck cancer, their customary dosing and side effects.

2. The impact of induction and/or adjuvant chemotherapy combined with surgery and radiation therapy as defined by randomized trials, including a discussion of the Head &Neck Contracts program and the Intergroup adjuvant trial.

3. The development of larynx/function preservation treatment programs, including a review of the Veterans Administration and EORTC larynx preservation studies.

4. The evolving role of chemotherapy as part of innovative combined modality programs, especially in patients with unresectable disease. The rationale and utility of sequential versus concomitant/alternating chemotherapy-radiation strategies, and relevant randomized clinical trials comparing the different strategies will be discussed.

5. The appropriate application of chemotherapy in the palliative setting, including a discussion of the relative merits of single-agent versus combination chemotherapy.

110 Breast Cancer: Postoperative Irradiation and Management of Locally Advanced Disease

Robert R. Ku&e, M.D. Ochsner Clinic, New Orleans, LA

PurDose/Objective: This course will review current indications for postoperative irradiation, present a videotape demonstration of a simulation technique for comprehensive chest wall/nodal irradiation, and discuss multimodality approaches to the difficult problem of locally advanced breast cancer.

As part of an expanding role for the radiation oncologist in the treatment of all stages of breast cancer, recent data has inspired a reevaluation of chest wall and nodal irradiation following mastectomy. A decade ago, ad&want irradiation was considered by many oncologists to be of no survival advantage or perhaps even harmful. Studies leading to this conclusion will be reviewed with special attention to the inadequacies and flawed constructs which biased these studies against adjuvant chest wall/nodal irradiation. The Fischer hypothesis or “new paradigm” will be challenged. Can improvement in local control result in improved survival? If the goal of treatment is simply to reduce local-regional recurrence, a three-field technique covering the chest wall and supraclavicular nodes may suffice. But if the goal is an improvement in survival based on the treatment of all locoregional sites which may not be sterilized by chemotherapy and mastectomy, a more complex set of fields is required. Based on this premise, we designed a 5-field technique of comprehensive chest wall and nodal irradiation. Simulation of these fields will be demonstrated on videotape.

Treatment strategies for both non-inflammatory and inflammatory non-metastatic breast cancer will be presented. Current recommendations include various combinations of chemohormonotherapy, radiation therapy, and mastectomy, but Controversies abound regarding the proper sequencing of these modalities, whether breast conservation therapy can be offered to patients who have a dramatic response to systemic therapy, and whether or not any one of these treatment modalities can be dropped under specific clinical scenarios.

111 Thyroid Cancer: Natural History, Management Strategies and Outcomes

Ashok R. Shaha, M.D. Memorial Sloan-Kettering Cancer Center, New York, NY

Obiectives:

l To understand the natural history of thyroid cancer and high risk groups l To define the biological behavior of thyroid cancer and relate it to various prognostic factors and risk groups l To divide the management strategies into conservation, radical surgery and radioactive iodine treatment. l To define the role of external radiation therapy and the management of complex and advanced thyroid cancer l To analyze the results of management of anaplastic thyroid cancer and make a plea for combined modality treatment l To define the current role of genetic studies in medullary thyroid cancer. At the end of this refresher course, the attendees will be able to understand the natural history, the prognostic factors and risk groups and surgical and combined modality treatment in thyroid cancer.