Management of far advanced and recurrent head and neck cancer is a common, complex and costly clinical dilemma. One third to one half of all head and neck cancer patients will develop persistent or recurrent disease within the first five years post treatment. Once recurrent after primary treatment,, survival rates for head and neck cancers are very poor. Nearly all of these patients will die within one year, usually with severe functional and cosmetic problems. The role of chemotherapy in management of far advanced head and neck cancer who failed previous surgery and radiation therapy is not fully elucidated. The potential benefit of chemotherapy must be weighed against the potential for systemic toxicity and cost. Recent single/combination chemotherapy trials reported a median survival rate of 6.5 months. An attractive solution to these problems would be the development of a new adjunctive method combining the best features of interstitial therapy for selective tumor destruction via minimally invasive techniques for access and ultrasound (UTZ) or ultrafast magnetic resonance images (MRI) as a monitoring system of the treatment. Interstitial tumor therapy (ITT) is a technique whereby a source of energy (laser, radiofrequency, ultrasonic, cryoenergy, etc.) is directly applied into tumors at various depths. Recent experimental studies have demonstrated the efficiency of UTZ and MRI for real and/or """"""""near"""""""" real time tumor and vessel identification as well as monitoring and quantifying energy induced tissue damage. Review of our pilot clinical experience using UTZ guided minimally invasive interstitial Nd:YAG laser/ ultrasonic treatment of recurrent head and neck tumor reveals that the technique is feasible with a median survival rate of 18 months. The overall objectives of this phase II clinical trail are to: 1. Test the effectiveness, practicality and safety of UTZ guided interstitial Nd:YAG laser/ultrasonic palliative tumor therapy in patients with recurrent, unresectable head and neck carcinomas. 2. Evaluate the clinical outcome of therapy as measured by changes in tumor volume, rates of complications and psychosocial functions.
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