Re-irradiation of Head and Neck Malignancies

Loco-regional recurrence and development of second primary head and neck cancers remain significant issues for patients with locally advanced head and neck cancer following definitive treatment and contribute to substantial morbidity and early mortality (Pignon et al. Radiother Oncol 92(1):4-14, 2009; Chao et al. Int J Radiat Oncol Biol Phys 55(2):312–21, 2003). Up to 50% of patients develop a local recurrence within 5 years. Both scenarios may warrant consideration of re-irradiation with or without systemic therapy but should be discussed in a multidisciplinary head and neck cancer tumor board. Patients with recurrent disease or second primary head and neck cancers who are appropriate and amenable for salvage surgery should receive this as first line therapy. There is an accumulating literature reporting the safety and efficacy of re-irradiation for head and neck cancer patients. Multiple therapeutic techniques for salvage re-irradiation or for management of second primary are available and include conventionally fractionated photon or proton radiotherapy with or without systemic therapy or SBRT with or without biotherapy or checkpoint inhibitor.