Surgery, Radiation Therapy, and Combination Chemotherapy in Treating Patients With Recurrent Head and Neck Cancer

Inclusion Criteria

• •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