title: Efficacy and toxicity of reirradiation using intensity-modulated radiotherapy for recurrent or second primary head and neck cancer.
abstract: BACKGROUND
  Patients with locally recurrent squamous cell cancer of the head and neck (SCCHN) are reported to have a poor prognosis and limited therapeutic options. Optimal management is selectively applied and morbid. Both surgical resection and chemoradiotherapy are reported to result in median survivals of approximately 12 months. Intensity-modulated radiotherapy (IMRT) is a highly conformal approach for delivering RT. This study reported the experience of the Dana-Farber Cancer Institute (DFCI) with IMRT-based chemoradiotherapy with or without surgery for locally recurrent SCCHN.
  
  
  METHODS
  The current study was a retrospective study of all patients treated at DFCI who were diagnosed with nonmetastatic second primary or recurrent SCCHN and who received reirradiation based on IMRT. The primary endpoint was overall survival (OS), and secondary endpoints were locoregional (LRC) and distant control and acute and chronic toxicity.
  
  
  RESULTS
  Thirty-five patients were treated from August 2004 until December 2008. Recurrent disease was treated in the oral cavity (4 patients), larynx/hypopharynx (13 patients), oropharynx (7 patients), nasopharynx (2 patients), and neck (9 patients). The median radiation dose was 60 Gray (Gy), and all patients received concurrent chemotherapy. The median follow-up was 2.3 years. The 2-year actuarial OS and LRC rates were 48% and 67%, respectively. Approximately 91% and 46%, respectively, of all patients developed at least 1 acute and late grade 3 toxicity. Four (11%) late deaths occurred in patients with no evidence of disease (2 aspiration events, 1 oropharyngeal hemorrhage, and 1 infectious death).
  
  
  CONCLUSIONS
  Aggressive chemoradiotherapy with IMRT was found to be feasible and resulted in favorable survival outcomes in comparison with published reports. Acute and late toxicities were substantial. The apparently improved LRC appears to carry a significant risk of developing late complications.
authors.affiliation: Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA. dsher@lroc.harvard.edu
authors.forename: David J
authors.initials: DJ
authors.lastname: Sher
authors.forename: Robert I
authors.initials: RI
authors.lastname: Haddad
authors.forename: Charles M
authors.initials: CM
authors.lastname: Norris
authors.forename: Marshall R
authors.initials: MR
authors.lastname: Posner
authors.forename: Lori J
authors.initials: LJ
authors.lastname: Wirth
authors.forename: Laura A
authors.initials: LA
authors.lastname: Goguen
authors.forename: Donald
authors.initials: D
authors.lastname: Annino
authors.forename: Tracy
authors.initials: T
authors.lastname: Balboni
authors.forename: Aaron
authors.initials: A
authors.lastname: Allen
authors.forename: Roy B
authors.initials: RB
authors.lastname: Tishler
mesh_terms: D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery; D003131:Combined Modality Therapy; D005260:Female; D006258:Head and Neck Neoplasms / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000532:radiotherapy; D016609:Neoplasms, Second Primary / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects; D019233:Retreatment; D012189:Retrospective Studies; D016019:Survival Analysis