The role of re-irradiation of secondary and recurrent head and neck carcinomas. Is it a potentially curative treatment? A practical approach

  • Jon Cacicedo
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    Cruces University Hospital, Radiation Oncology Department, c/Plaza de Cruces s/n, 48903 Barakaldo, Vizcaya (Basque Country), Spain
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    Arturo Navarro
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    Radiation Oncology Department, Hospital Duran i Reynals (ICO), Avda. Gran VIa de ĹHospitalet 199-203, Hospitalet de Llobregat, 08908 Barcelona, Spain
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    Filippo Alongi
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    Radiation Oncology Department, Humanitas Cancer Center, Istituto Clinico Humanitas Via Manzoni 56, 20089 Rozzano (Milano), Italy
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    Alfonso Gómez de Iturriaga
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    Cruces University Hospital, Radiation Oncology Department, c/Plaza de Cruces s/n, 48903 Barakaldo, Vizcaya (Basque Country), Spain
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    Olga del Hoyo
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    Elsira Boveda
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    Francisco Casquero
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    Jose Fernando Perez
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    Cruces University Hospital, Medical Physics Department, c/Plaza de Cruces s/n, 48903 Barakaldo, Vizcaya (Basque Country), Spain
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    Pedro Bilbao
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Published:August 29, 2013DOI:https://doi.org/10.1016/j.ctrv.2013.08.002

      Abstract

      Despite aggressive efforts to cure head and neck cancer patients, including altered fractionation and the addition of chemotherapy to radiation, locoregional recurrence remains a serious issue to face in clinical practice. Indeed, recurrent and second primary tumors occurring in previously irradiated area are common clinical challenge. Whenever possible, patients are advised to undergo salvage surgery. Nevertheless, few patients are suitable candidates for curative resection. In such cases, chemotherapy alone has traditionally been considered, with a poor response rate.
      It has been questioned whether re-irradiation toxicity outweighs the potential benefits, considering that the median survival of re-irradiated patients marginally exceeds the benefits observed with chemotherapy alone. However, full-dose re-irradiation is a viable treatment option, offering long-term survival for selected patients.
      Moreover, several prognostic factors should be considered for patients undergoing re-irradiation, such as basic patient characteristics, performance status, the location and extension of recurrent disease, patient co-morbidities, current speech and swallowing function, the interval from the initial radiation therapy to recurrence, previously received doses by critical structures and prior treatment toxicity. Nevertheless, several questions remain unanswered.
      The purpose of this review is to evaluate the major issues in the field of re-irradiation regarding the current evidence. Therefore, the major selection criteria and new treatment strategies are discussed to define the ideal candidates to undergo re-irradiation and describe a practical approach to these patients.
      Given the limited evidence in this field, the optimal treatment of recurrent and second primary cancers remains to be defined. Future prospective study of this approach is warranted.

      Keywords

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