OBJECTIVES:

• Determine the effectiveness and toxic effects of intensive salvage therapy and radiotherapy in previously irradiated patients with recurrent head and neck cancer.
• Determine the feasibility and effectiveness of amifostine at limiting or minimizing side effects of repeat irradiation in these patients.

OUTLINE: Patients undergo surgical resection of gross disease (if not already done) followed by 4-6 weeks of rest. Patients receive radiotherapy over 5 consecutive days on weeks 1, 2, 4, and 5. Intravenous cisplatin is administered on days 1-3 and 29-31. Intravenous amifostine is administered 15-30 minutes prior to radiotherapy and cisplatin therapy. Patients receive fluorouracil IV continuously on days 1-4 and 29-32.

Patients are followed every month for 1 year, every 2 months for 1 year, every 3 months for 1 year, every 4 months for 1 year, then every 6 months thereafter.

PROJECTED ACCRUAL: A total of 35 patients will be accrued for this study.

DISEASE CHARACTERISTICS:

• Histologically confirmed recurrent or new primary squamous cell carcinoma of the head and neck occurring in a previously irradiated field
• Pathologic stage of recurrence must be rT3-4 and/or rN2-3

• The following sites are eligible:

  • Oral cavity, oropharynx, or hypopharynx: Any rT2-4 and/or clinical rN+
  • Larynx: Any rT4, rT3 with perineural invasion, or any rT with clinical rN+
  • Any site: Positive margin(s), at least 2 nodes or ECS
• No primary tumor of the nasopharynx
• Must be eligible for or have undergone complete resection which leaves behind no gross residual disease
• Must have prior head and neck irradiation of 45-75 Gy
• Lifetime spinal cord radiotherapy dose no greater than 50 Gy
• No ongoing RTOG late morbidity of grade 3 or greater (unless correctable by surgery)
• No active acute radiation mucositis from previous radiotherapy

PATIENT CHARACTERISTICS:

Age:

• 18 and over

Performance status:

• Karnofsky 70-100%

Life expectancy:

• Not specified

Hematopoietic:

• WBC at least 4,000/mm^3
• Hemoglobin at least 9 g/dL (transfusion allowed)
• Platelet count at least 100,000/mm^3

Hepatic:

• SGOT or SGPT no greater than 3 times upper limit of normal
• Bilirubin no greater than 2 mg/dL

Renal:

• Creatinine no greater than 1.5 mg/dL

Cardiovascular:

• No myocardial infarction, unstable angina, coronary heart failure, or uncontrolled arrhythmias within past 6 months
• No severe cerebrovascular disease or hypotension not caused by antihypertensive medication

Other:

• Not pregnant
• Fertile patients must use effective contraception
• No allergy to cisplatin, fluorouracil, or amifostine
• No uncontrolled insulin-dependent diabetes mellitus or other medical condition interfering with wound healing

PRIOR CONCURRENT THERAPY:

Biologic therapy:

• Not specified

Chemotherapy:

• No prior chemotherapy for tumor recurrence (except adjuvant chemotherapy)

Endocrine therapy:

• Not specified

Radiotherapy:

• See Disease Characteristics
• At least 6 months since prior radiotherapy
• Prior radiotherapy treatment records must be available

Surgery:

• No prior salvage surgery consisting of partial laryngectomy