Adenoidcystic carcinoma of the head and neck: Results of a new chemotherapy regimen with 5-fluorouracil / leucovorin / 4-epirubicin in recurrent disease

Introduction : Management of adenoidcystic carcinoma includes surgical resection and adjuvant radiotherapy. Surgery in recurrent disease is extensive or mutilating in most cases. Additional radiotherapy in preirradiated patients is difficult regarding to critical anatomical structures e.g. chiasma opticum. We introduce a new chemotherapy regimen for recurrent disease in adenoidcystic carcinoma of the head and neck region. Methods and materials : 6 patients (4 f/ 2 m) with a median age of 53 years were included with a well documentated relapse of adenoideystic carcinoma. 5/6 patients had operations, 616 radiotherapy with a median dose of 54 Gy (46-60 Gy) and 2/6 had chemotherapy with gemcitabine and cis-platin/5-fluorouracil) as pretreatment. The new chemotherapy scheme consisted of a weekly application of 5-fluorouracil 2000 mg/m²/24h, leucovorin 200mg/m²/ 30 min. and every second week additionally 4-epirubicin 30mg/m². 7 cycles (4-41) of chemotherapy were given in median until remission or stable disease was achieved. Results : 1/6 patients had a complete remission, 3/6 showed partial remission and 2/6 had a no change with a median duration of tumor stabilization of 9 month (3-23). Acute toxicity was low (mucositis and emesis CTC °I). Conclusion : Chemotherapy with 5-fluorouracil/leucovorin/ 4-epirubicin is highly effective with well tolerable side-effects in patients with pre-treated adenoidcystic carcinoma of the head and neck region. This scheme produces longlasting tumor stabilization and seems to be a good treatment option in recurrent disease.