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Re-irradiation: New Frontiers pp 101–115Cite as

Head and Neck Cancer

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Part of the book series: Medical Radiology ((Med Radiol Radiat Oncol))

Abstract

Re-irradiation for loco-regional failure of head and neck cancer or second primary tumours in previously irradiated areas after a full course of (chemo) radiation poses a challenging problem for radiation oncologists. Salvage surgery remains the standard of care which, however, is the case in only 20% of the cases. Chemotherapy alone is not considered a curative treatment option. Curatively intended (chemo-) radiation should be considered in well-selected cases and can be administered safely with a reasonable chance of long term survival (approximately 15–20%) but at the cost of increased acute and late toxicity. The results of taxane-based chemo-re-irradiation protocols are most promising. In case of adverse prognostic factors, immediate postoperative (chemo-) re-irradiation after salvage surgery can be administered safely and significantly improves loco-regional control. Severe treatment-related morbidity remains of major concern. However, most series on re-irradiation published so far did not use the most optimal fractionation and technique. Improvement of the therapeutic ratio can be expected from altered fractionation schedules, by limiting the target volume to the high risk areas and by using more advanced radiation delivery techniques. Future studies should focus on new developments that proved to be effective in the primary treatment of HNSCC. In this respect, new induction chemotherapy regimens such as TPF and the addition of cetuximab to radiation are of great interest as these approaches might improve locoregional control and overall without increasing treatment-related morbidity.

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Authors and Affiliations

  1. Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands

    Johannes A. Langendijk

Authors
  1. Johannes A. Langendijk
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Correspondence to Johannes A. Langendijk .

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  1. , Dept. Internal Medicine, Nordlandssykehuset HF, Prinsensgate 164, Bodoe, 8092, Norway

    Carsten Nieder

  2. Department of Radiation Oncology, University Medical Center Groningen, Hanzeplein 1, Groningen, 9700 RB, Netherlands

    Johannes A. Langendijk

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© 2010 Springer-Verlag Berlin Heidelberg

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Langendijk, J.A. (2010). Head and Neck Cancer. In: Nieder, C., Langendijk, J. (eds) Re-irradiation: New Frontiers. Medical Radiology(). Springer, Berlin, Heidelberg. https://doi.org/10.1007/174_2010_73

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  • DOI: https://doi.org/10.1007/174_2010_73

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  • Print ISBN: 978-3-642-12467-9

  • Online ISBN: 978-3-642-12468-6

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