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Reirradiation of Recurrent and Second Primary Cancers of the Head and Neck: a Review of the Contemporary Evidence

  • Head and Neck Cancer (PL Swiecicki, Section Editor)
  • Published:
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Opinion statement

Recurrent and second primary head and neck cancers represent a clinical challenge due to frequently unresectable and/or locally advanced disease. Given that many of these patients have received definitive doses of radiation previously, reirradiation is associated with significant morbidity. Use of modern approaches such as conformal photon-based planning and charged particle therapy using protons or carbon ions allows for greater sparing of normal tissues while maintaining or escalating doses to tumor volumes. While the reirradiation data has consistently shown benefits to local control and even survival from escalation of radiotherapy dose, excessive cumulative doses can result in severe toxicities, including fatal carotid blowout syndrome. For all modalities, appropriate patient selection is of utmost importance. Large-scale trials and multi-institutional registry data are needed to standardize treatment modalities, and to determine optimal doses and volumes for reirradiation.

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Funding

V.T. acknowledges support from the United States Department of Veterans Affairs Biomedical Laboratory Research and Development Service [IK2 BX004360].

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Authors and Affiliations

  1. University of Cincinnati Departments of Radiation Oncology, Cincinnati, OH, USA

    Paul J. Kreinbrink MD, Luke M. Lewis MD, Kevin P. Redmond MD & Vinita Takiar MD, PhD

  2. Cincinnati VA Medical Center, Cincinnati, OH, USA

    Vinita Takiar MD, PhD

  3. University of Cincinnati Medical Center, 234 Goodman Street, ML 0757, Cincinnati, OH, 45267, USA

    Vinita Takiar MD, PhD

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Correspondence to Vinita Takiar MD, PhD.

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Paul J. Kreinbrink declares that he has no conflict of interest. Luke M. Lewis declares that he has no conflict of interest. Kevin P. Redmond declares that he has no conflict of interest. Vinita Takiar has received research funding from Merck, and has received an honorarium for participating in a National Institutes of Health (NIH) Study Section.

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Kreinbrink, P.J., Lewis, L.M., Redmond, K.P. et al. Reirradiation of Recurrent and Second Primary Cancers of the Head and Neck: a Review of the Contemporary Evidence. Curr. Treat. Options in Oncol. 23, 295–310 (2022). https://doi.org/10.1007/s11864-021-00936-y

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