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

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.

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McDonald MW, Lawson J, Garg MK, Quon H, Ridge JA, Saba N, et al. ACR appropriateness criteria retreatment of recurrent head and neck cancer after prior definitive radiation expert panel on radiation oncology- head and neck cancer. Int J Radiat Oncol Biol Phys 2011;80(5):1292–8.
Kim YS. Reirradiation of head and neck cancer in the era of intensity-modulated radiotherapy: patient selection, practical aspects, and current evidence. Radiat Oncol J 2017;35(1):1–15.
Janot F, de Raucourt D, Benhamou E, Ferron C, Dolivet G, Bensadoun RJ, et al. Randomized trial of postoperative reirradiation combined with chemotherapy after salvage surgery compared with salvage surgery alone in head and neck carcinoma. J Clin Oncol 2008;26(34):5518–23.
Popovtzer A, Gluck I, Chepeha DB, Teknos TN, Moyer JS, Prince ME, et al. The pattern of failure after reirradiation of recurrent squamous cell head and neck cancer: implications for defining the targets. Int J Radiat Oncol Biol Phys 2009;74(5):1342–7.
Chen AM, Farwell DG, Luu Q, Cheng S, Donald PJ, Purdy JA. Prospective trial of high-dose reirradiation using daily image guidance with intensity-modulated radiotherapy for recurrent and second primary head-and-neck cancer. Int J Radiat Oncol Biol Phys 2011;80(3):669–76.
Chang JH, Wu CC, Yuan KS, Wu ATH, Wu SY. Locoregionally recurrent head and neck squamous cell carcinoma: incidence, survival, prognostic factors, and treatment outcomes. Oncotarget 2017;8(33):55600–12.
Unger KR, Lominska CE, Deeken JF, Davidson BJ, Newkirk KA, Gagnon GJ, et al. Fractionated stereotactic radiosurgery for reirradiation of head-and-neck cancer. Int J Radiat Oncol Biol Phys 2010;77(5):1411– 9.
Cengiz M, Özyiğit G, Yazici G, Doğan A, Yildiz F, Zorlu F, et al. Salvage reirradiaton with stereotactic body radiotherapy for locally recurrent head-and-neck tumors. Int J Radiat Oncol Biol Phys 2011;81(1):104–9.
Vargo JA, Heron DE, Ferris RL, Rwigema JC, Kalash R, Wegner RE, et al. Examining tumor control and toxicity after stereotactic body radiotherapy in locally recurrent previously irradiated head and neck cancers: implications of treatment duration and tumor volume. Head Neck 2014;36(9):1349–55.
Lartigau EF, Tresch E, Thariat J, Graff P, Coche-Dequeant B, Benezery K, et al. Multi institutional phase II study of concomitant stereotactic reirradiation and cetuximab for recurrent head and neck cancer. Radiother Oncol 2013;109(2):281–5.
Vargo JA, Ferris RL, Ohr J, Clump DA, Davis KS, Duvvuri U, et al. A prospective phase 2 trial of reirradiation with stereotactic body radiation therapy plus cetuximab in patients with previously irradiated recurrent squamous cell carcinoma of the head and neck. Int J Radiat Oncol Biol Phys 2015;91(3):480–8.
Heron DE, Rwigema JC, Gibson MK, Burton SA, Quinn AE, Ferris RL. Concurrent cetuximab with stereotactic body radiotherapy for recurrent squamous cell carcinoma of the head and neck: a single institution matched case-control study. Am J Clin Oncol 2011;34(2):165–72.
Vargo JA, Ward MC, Caudell JJ, Riaz N, Dunlap NE, Isrow D, et al. A Multi-institutional Comparison of SBRT and IMRT for Definitive Reirradiation of Recurrent or Second Primary Head and Neck Cancer. Int J Radiat Oncol Biol Phys 2018;100(3):595–605.
Margalit DN, Wong SJ. Reirradiation for Head and Neck Cancer: The Who and the How. Int J Radiat Oncol Biol Phys 2018;100(3):618–20.
Powitzky R, Vasan N, Krempl G, Medina J. Carotid blowout in patients with head and neck cancer. Ann Otol Rhinol Laryngol 2010;119(7):476–84.
Kirkpatrick JP, van der Kogel AJ, Schultheiss TE. Radiation dose-volume effects in the spinal cord. Int J Radiat Oncol Biol Phys 2010;76(3 Suppl):S42–9.
Yazici G, Sanlı TY, Cengiz M, Yuce D, Gultekin M, Hurmuz P, et al. A simple strategy to decrease fatal carotid blowout syndrome after stereotactic body reirradiaton for recurrent head and neck cancers. Radiat Oncol 2013;8:242.
Gebhardt BJ, Vargo JA, Ling D, Jones B, Mohney M, Clump DA, et al. Carotid Dosimetry and the Risk of Carotid Blowout Syndrome After Reirradiation With Head and Neck Stereotactic Body Radiation Therapy. Int J Radiat Oncol Biol Phys 2017 Dec 5 [Epub ahead of print], doi: 10.1016/j.ijrobp.2017.11.045