**Re-irradiation for Recurrent Head and Neck Cancer**

Viktoras Rudzianskas and Rita Kupcinskaite‐Noreikiene

Additional information is available at the end of the chapter

http://dx.doi.org/10.5772/67060

#### **Abstract**

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10.1016/j.radonc.2016.03.011. [Epub ahead of print]

Radiat Res. 2016 Dec 15. [Epub ahead of print]

doi: 10.1186/1471-2407-14-447.

104 Radiotherapy

After radical treatment of head and neck cancer about 20–50% of patients are diagnosed with the locoregional recurrence during first two years. The main treatment for recurrent disease is salvage surgery, but in most cases, surgery is not feasible due to the high risk of complications and morbidity, and only 20% of patients are suitable for surgical salvage. Reirradiation is an effective treatment method with acceptable toxicity, but this treatment method is limited to normal tissue tolerance to a total dose. When chemotherapy is administered for recurrence, the response rate is up to 40%, so with the advancement of technical measures, after introduction of intensity‐modulated radiotherapy, fractionated stereotactic body radiation therapy, high‐dose‐rate brachytherapy, proton beam reirradiation, a reirradiation is increasingly more often used for head and neck cancer relapse treatment. In this chapter, we will discuss about reirradiation with curative intent using new different radiation techniques (intensity‐modulated radiotherapy (IMRT), stereotactic body radiation therapy (SBRT), high‐dose‐rate brachytherapy (HDR‐BRT) and proton beam reirradiation (PBRT) for previously irradiated head and neck cancer and present recommendations for retreatment of head and neck cancer relapse using reirradiation alone or with systemic chemotherapy/biologic therapy.

**Keywords:** reirradiation, head and neck cancer, brachytherapy, proton beam therapy, stereotactic body radiation

### **1. Introduction**

Despite the sophisticated methods of cancer diagnosis, more than 50% of cases are still diagnosed when the disease has reached III/IV stage. After radical treatment of head and neck cancer, about 20–50% of patients are diagnosed with the locoregional recurrence during first two years [1–3]. The main treatment for recurrent disease is salvage surgery, but in most cases, surgery is not feasible due to the high risk of complications and morbidity, and only 15–30%

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of patients are suitable for surgical salvage [4–8], and 5‐year overall survival is 16–36% [9–14]. When chemotherapy is administered for recurrence, the response rate is up to 35–40%, and median overall survival is about 10% [15–17]. The results of retrospective studies presented in literature, using reirradiation by three‐dimensional radiotherapy (3D‐RT) for head and neck cancer recurrence, according to a 2‐year overall survival and toxicity, are poor: overall survival reached 15.2–40%, the rate of severe late toxicities (grade 3 and 4) reached 1.4–47%, the rate of degree 5 (lethal) complications reached 7.6% [18–21]. However, with the advancement of technical measures, after introduction of intensity‐modulated radiotherapy (IMRT), fractionated stereotactic body radiation therapy (F‐SBRT), high‐dose‐rate brachytherapy (HDR‐ BRT), proton beam reirradiation (PBRT), a reirradiation is increasingly more often used for head and neck cancer relapse treatment [6, 18, 22–24].

In this chapter, we will discuss about reirradiation with curative intent using new different radiation techniques (IMRT, SBRT, HDR‐BRT and PBRT) for previously irradiated head and neck cancer and present recommendations for retreatment of head and neck cancer relapse using reirradiation alone or with systemic chemotherapy/biologic therapy.
