Re-irradiation in the management of isolated neck recurrences: current status and recommendations.
Recent times have witnessed significant improvements in outcome for head and neck squamous cell carcinomas. Nevertheless, the major pattern of failure continues to remain loco-regional. Isolated neck recurrence, although uncommon, occurs in 5-7% of patients after radical treatment. The options for this subgroup are somewhat limited and are often guided by empiricism rather than evidence. This review attempts to systematically analyze the therapeutic options for patients with isolated neck recurrence following radical treatment for the primary and draining cervical lymph nodes, with a special emphasis on re-irradiation. Salvage neck dissection offers the best chance of cure to patients with resectable neck recurrences. The perceived increased risk of complications of re-irradiation following previous curative dose irradiation has precluded optimal evaluation of its potential in this setting. Post-operative adjuvant re-irradiation should be based on histo-pathological findings of the salvage surgery. Re-irradiation with or without chemotherapy may be considered for unresectable neck recurrences. The role of chemotherapy continues to evolve and is presently not optimally defined. There is lack of high-quality evidence pertinent to salvage therapy leading to vast variations in practice. More patients with recurrent disease should be enrolled onto prospective clinical trials with relevant and meaningful endpoints.
Chopra
Supriya
S
Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, India.
Gupta
Tejpal
T
Agarwal
Jai Prakash
JP
Budrukkar
Ashwini
A
Ghosh-Laskar
Sarbani
S
Dinshaw
Ketayun
K
D002294:Carcinoma, Squamous Cell / Q000188:drug therapy / Q000532:radiotherapy* / Q000601:surgery; D006258:Head and Neck Neoplasms / Q000188:drug therapy / Q000532:radiotherapy* / Q000601:surgery; D006801:Humans; D037981:Neck Dissection / Q000401:mortality; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy / Q000532:radiotherapy* / Q000601:surgery; D017410:Practice Guidelines as Topic; D011879:Radiotherapy Dosage; D019233:Retreatment / Q000379:methods; D016879:Salvage Therapy / Q000009:adverse effects / Q000379:methods*