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    Oropharyngeal Cancer Treatment (PDQ®): Treatment - Health Professional Information [NCI] - Recurrent and Metastatic Oropharyngeal Cancer

    Standard treatment options:

    1. Surgical resection if radiation therapy fails and if technically feasible.[1]
    2. Radiation therapy when surgery fails if not previously given in curative doses that preclude further treatment.[2]
    3. Surgical salvage when surgery fails and if technically feasible.[1]
    4. Chemotherapy for metastatic or unresectable locoregionally recurrent disease.
    5. Reirradiation therapy using conventionally fractionated radiation therapy, or hyperfractionated radiation therapy (HFX) with comcomitant chemotherapy.[3]

    Treatment options under clinical evaluation:

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    1. Clinical trials evaluating the use of chemotherapy and antiepidermal growth factor receptor-monoclonal targeted therapy should be considered.[4,5,6,7,8,9]
    2. Clinical trials evaluating reirradiation therapy using HFX with concomitant chemotherapy, targeted therapy, or stereotactic body radiation therapy.[10]

    Posttreatment follow-up:

    • A careful head and neck examination allows the phyisican to look for recurrence monthly for the first posttreatment year, every 2 months for the second year, every 3 months for the third year, and every 6 months thereafter. If the patient has metastatic disease or local recurrence that is no longer amenable to surgery or radiation, chemotherapy is the next consideration.

    Current Clinical Trials

    Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with recurrent oropharyngeal cancer. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.

    General information about clinical trials is also available from the NCI Web site.

    References:

    1. Wong LY, Wei WI, Lam LK, et al.: Salvage of recurrent head and neck squamous cell carcinoma after primary curative surgery. Head Neck 25 (11): 953-9, 2003.
    2. Vikram B, Strong EW, Shah JP, et al.: Intraoperative radiotherapy in patients with recurrent head and neck cancer. Am J Surg 150 (4): 485-7, 1985.
    3. Spencer SA, Harris J, Wheeler RH, et al.: RTOG 96-10: reirradiation with concurrent hydroxyurea and 5-fluorouracil in patients with squamous cell cancer of the head and neck. Int J Radiat Oncol Biol Phys 51 (5): 1299-304, 2001.
    4. Hong WK, Bromer R: Chemotherapy in head and neck cancer. N Engl J Med 308 (2): 75-9, 1983.
    5. Kish JA, Ensley JF, Jacobs J, et al.: A randomized trial of cisplatin (CACP) + 5-fluorouracil (5-FU) infusion and CACP + 5-FU bolus for recurrent and advanced squamous cell carcinoma of the head and neck. Cancer 56 (12): 2740-4, 1985.
    6. Vogl SE, Schoenfeld DA, Kaplan BH, et al.: A randomized prospective comparison of methotrexate with a combination of methotrexate, bleomycin, and cisplatin in head and neck cancer. Cancer 56 (3): 432-42, 1985.
    7. Jacobs C, Lyman G, Velez-García E, et al.: A phase III randomized study comparing cisplatin and fluorouracil as single agents and in combination for advanced squamous cell carcinoma of the head and neck. J Clin Oncol 10 (2): 257-63, 1992.
    8. Vermorken JB, Mesia R, Rivera F, et al.: Platinum-based chemotherapy plus cetuximab in head and neck cancer. N Engl J Med 359 (11): 1116-27, 2008.
    9. Vermorken JB, Stöhlmacher-Williams J, Davidenko I, et al.: Cisplatin and fluorouracil with or without panitumumab in patients with recurrent or metastatic squamous-cell carcinoma of the head and neck (SPECTRUM): an open-label phase 3 randomised trial. Lancet Oncol 14 (8): 697-710, 2013.
    10. Tortochaux J, Tao Y, Tournay E, et al.: Randomized phase III trial (GORTEC 98-03) comparing re-irradiation plus chemotherapy versus methotrexate in patients with recurrent or a second primary head and neck squamous cell carcinoma, treated with a palliative intent. Radiother Oncol 100 (1): 70-5, 2011.

    This information is produced and provided by the National Cancer Institute (NCI). The information in this topic may have changed since it was written. For the most current information, contact the National Cancer Institute via the Internet web site at http:// cancer .gov or call 1-800-4-CANCER.

    WebMD Public Information from the National Cancer Institute

    Last Updated: May 28, 2015
    This information is not intended to replace the advice of a doctor. Healthwise disclaims any liability for the decisions you make based on this information.
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