• 6/9/2006
  • Madison, WI
  • Stuart J. Wong, Mitchell Machtay, Yi Li
  • Journal of Clinical Oncology, Vol 24, No 17 (June 10), 2006: pp. 2653-2658

Patients with locally recurrent head and neck cancer previously treated with radiation have a poor prognosis. Administration of a second course of radiation to tissues within a previous radiation portal, has been traditionally considered unsafe.

Survival rates of highly selected patients treated with concurrent chemotherapy and re-irradiation may be as high as 25% at 2 years—exceeding the outcome of matched historical controls treated with chemotherapy alone (10%). However, many questions exist regarding the use of re-irradiation.

Uncertainty exists over the criteria for selecting patients who are most appropriate for treatment with re-irradiation. Even greater concern exists regarding toxicity and functional sequelae associated with the use of re-irradiation. Whether the benefits of re-irradiation on locoregional disease control and survival outweigh its potentially severe and life-threatening adverse effects is not clear.

In this review, we will discuss re-irradiation and other treatment options for squamous cell carcinoma patients with previously irradiated, locoregional recurrent or second primary tumors in the head and neck, and describe a recently initiated randomized trial comparing chemotherapy plus re-irradiation with chemotherapy.

Authors’ affiliation:
From the Division of Neoplastic Diseases, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI; Department of Radiation Oncology, Jefferson Medical College/ Bodine Cancer Center, Philadelphia, PA; and Harvard School of Public Health, Dana-Farber Cancer Institute, Boston, MA