Stereotactic Re-irradiation for Recurrent or Second Primary Head-and-Neck Cancer

Abstract

Local recurrence after definitive radiotherapy for advanced head-and-neck cancer is observed in 30%–60% of the patients. Surgical resection is possible in only about 25% of the cases. Re-irradiation for localrecurrence is most of the times the only local treatment option. However, it is highly morbid with a poorsuccess rate. Stereotactic radiotherapy is a highly conformal radiotherapy technique, usually with hypofractionation.Most of the authors use 5–6 fractions by 6–8 Gy. Median OS rates vary between 12 and24.5 months. Concomitant use of cetuximab may also have some beneficial effects. Recent multicentricRPA analysis from North America suggested the classification of patients into prognostic groups and advisedselection of treatment protocols according to the RPA class of the patients. The authors also comparedIMRT with SBRT for re-irradiation. They could not show any significant difference between thetreatment techniques. Carotid artery blowout syndrome is one of the lethal toxicities of re-irradiation.Limiting radiation dose to the carotid artery is important for the prevention of such toxicities. However,there is currently no consensus pertaining to carotid artery doses in the literature.