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 local recurrence is most of the times the only local treatment option. However, it is highly morbid with a poor success rate. Stereotactic radiotherapy is a highly conformal radiotherapy technique, usually with hypo-fractionation. Most of the authors use 5-6 fractions by 6-8 Gy. Median OS rates vary between 12 and 24.5 months. Concomitant use of cetuximab may also have some beneficial effects. Recent multicentric RPA analysis from North America suggested the classification of patients into prognostic groups and advised selection of treatment protocols according to the RPA class of the patients. The authors also compared IMRT with SBRT for re-irradiation. They could not show any significant difference between the treatment 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.