Reirradiation after salvage surgery and microvascular free flap reconstruction for recurrent head and neck carcinoma.
OBJECTIVE
To evaluate the outcome and complications of reirradiation of recurrent head and neck cancer after salvage surgery and microvascular reconstruction.


METHODS
Retrospective.


METHODS
Twelve patients underwent salvage surgery with microvascular reconstruction for recurrent or second primary head and neck cancer in a previously irradiated field. Median prior radiation therapy dose was 63.0 Gy. Patients then underwent postoperative reirradiation, and received a median total cumulative radiation dose of 115.0 Gy.


RESULTS
Three (25%) patients experienced acute complications (<3 months) during reirradiation. Four (33%) patients developed grade 3 or 4 late reirradiation complications (>3 months). There were no incidences of free flap failure, brain necrosis, spinal cord injury, or carotid rupture. The incidence of soft tissue necrosis and osteoradionecrosis was 8%. Six (50%) patients are alive without evidence of recurrent disease a median of 40 months after reirradiation.


CONCLUSIONS
Microvascular free flaps allow for maximal resection and reliable reconstruction of previously irradiated cancers before high dose reirradiation and may reduce the incidence of severe late complications and treatment related mortality.
Suh
Jeffrey D
JD
Division of Head and Neck Surgery, University of California, Los Angeles, CA 90095-1624, USA. jsuh@mednet .ucla.edu
Kim
Brian P
BP
Abemayor
Elliot
E
Sercarz
Joel A
JA
Nabili
Vishad
V
Liu
Jerome H
JH
Juillard
Guy J
GJ
Blackwell
Keith E
KE
D000328:Adult; D000368:Aged; D003131:Combined Modality Therapy; D005260:Female; D006258:Head and Neck Neoplasms / Q000532:radiotherapy* / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000532:radiotherapy* / Q000601:surgery*; D016609:Neoplasms, Second Primary / Q000532:radiotherapy* / Q000601:surgery*; D011183:Postoperative Complications; D011878:Radiotherapy / Q000009:adverse effects; D019233:Retreatment; D012189:Retrospective Studies; D016879:Salvage Therapy; D013524:Surgical Flaps / Q000098:blood supply*; D015996:Survival Rate; D016896:Treatment Outcome