title: A phase II study of primary reirradiation in squamous cell carcinoma of head and neck.
abstract: OBJECTIVE
  In this prospective study, the effect of a second course of primary radiotherapy on locoregional control, survival and toxicity was investigated, in patients who underwent a second course of high dose irradiation for second primary or locoregional recurrent squamous cell head and neck carcinoma (HNSCC) in a previously irradiated area.
  
  
  METHODS
  A total of 34 patients with second primary (n=26) or locoregional recurrent (n=8) tumours were treated with a second course of high dose radiotherapy. Patients were selected for re-irradiation in case of inoperable and/or unresectable tumours. In most cases, the target volume for re-irradiation was confined to the gross tumour volume (GTV). No elective radiotherapy was applied in the former high-dose area. A total dose of 46 Gy was applied to elective areas with a boost up to 60 Gy with conventional fractionation. The median follow-up period was 32 months.
  
  
  RESULTS
  The locoregional control rate after 2 years was 27%. The 3-year overall survival was 22%. The most frequently reported acute side-effect was acute mucositis resulting in swallowing complaints. Pharyngeal and oesophageal late morbidity was also the most important late side-effect. In general, acute and late radiation-induced morbidity remained within acceptable limits.
  
  
  CONCLUSIONS
  In conclusion, primary re-irradiation appears to be feasible in terms of acute and late radiation-induced toxicity. To improve outcome in terms locoregional control and survival, future studies should be focussed on optimising radiation schedules and the addition of concomitant chemotherapy.
authors.affiliation: Department of Radiation Oncology, V U University Medical Center, Amsterdam, The Netherlands. j.a.langendijk@rt.umcg.nl
authors.forename: Johannes A
authors.initials: JA
authors.lastname: Langendijk
authors.forename: Nicolien
authors.initials: N
authors.lastname: Kasperts
authors.forename: Charles R
authors.initials: CR
authors.lastname: Leemans
authors.forename: Patricia
authors.initials: P
authors.lastname: Doornaert
authors.forename: Ben J
authors.initials: BJ
authors.lastname: Slotman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000401:mortality* / Q000532:radiotherapy*; D005260:Female; D006258:Head and Neck Neoplasms / Q000401:mortality* / Q000532:radiotherapy*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality* / Q000532:radiotherapy*; D009426:Netherlands / Q000453:epidemiology; D011832:Radiation Injuries / Q000401:mortality*; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome