Reirradiation for Head and Neck Cancer

Cancer Locoregional failure and second primary tumors are common conditions that clinicians must face in the treatment of head and neck cancers. The lack of prospective data and the significant limitations imposed by previous radiotherapy make it challenging to develop consistent treatment recommendations. The objective of this chapter is to provide a review of the current literature on reirradiation for head and neck cancer. Patient selection is key due to considerable toxicity associated with reirradiation, but this toxicity must always be weighed against the morbidity of disease progression. Surgery should be the mainstay of treatment for patients who are able to undergo resection, and postoperative reirradiation should typically be offered to those with high-risk pathologic factors. Definitive reirradiation should be considered for those who are not surgical candidates, and concurrent chemotherapy should be added when feasible. Stereotactic ablative radiotherapy can be a useful reirradiation technique, especially for small tumors. In addition, there is growing promising data on utilizing protons or carbon ions for reirradiation. Reirradiation can be an effective treatment strategy when properly utilized, but the therapeutic ratio must always be carefully considered in this population.