title: Reirradiation with intensity-modulated radiotherapy in recurrent head and neck cancer.
abstract: BACKGROUND
  In this retrospective investigation we analyzed outcome and toxicity after intensity-modulated reirradiation of recurrent head and neck cancer.
  
  
  METHODS
  Thirty-eight patients with local recurrent head and neck cancer were evaluated. The median dose of initial radiotherapy was 61 Gy. Reirradiation was carried out with step-and-shoot intensity-modulated radiotherapy (median dose: 49 Gy).
  
  
  RESULTS
  Median overall survival was 17 months, and the 1- and 2-year overall survival rates were 63% and 34%. The 1- and 2-year local control rates were 57% and 53%. Distant spread occurred in 34%, and reirradiation induced considerable late toxicity in 21% of the patients. Thirty-two percent showed increased xerostomia after reirradiation. The risk for xerostomia was significantly higher for cumulative mean doses of ≥45 Gy to parotid glands. Considering median cumulative maximum doses of 53 Gy to the spinal cord and 63 Gy to the brainstem, no late toxicities were observed.
  
  
  CONCLUSIONS
  Reirradiation with intensity-modulated radiotherapy in recurrent head and neck cancer is feasible with acceptable toxicity and yields encouraging rates of local control and overall survival.
authors.affiliation: Department of Radiation Oncology, University of Heidelberg, Heidelberg, Germany. F.Zwicker@dkfz.de
authors.forename: Felix
authors.initials: F
authors.lastname: Zwicker
authors.forename: Falk
authors.initials: F
authors.lastname: Roeder
authors.forename: Henrik
authors.initials: H
authors.lastname: Hauswald
authors.forename: Christian
authors.initials: C
authors.lastname: Thieke
authors.forename: Carmen
authors.initials: C
authors.lastname: Timke
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Schlegel
authors.forename: Juergen
authors.initials: J
authors.lastname: Debus
authors.forename: Marc W
authors.initials: MW
authors.lastname: Münter
authors.forename: Peter E
authors.initials: PE
authors.lastname: Huber
mesh_terms: D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000532:radiotherapy*; D005260:Female; D006258:Head and Neck Neoplasms / Q000401:mortality / Q000532:radiotherapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000532:radiotherapy*; D011879:Radiotherapy Dosage; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects; D019233:Retreatment; D000077195:Squamous Cell Carcinoma of Head and Neck; D015996:Survival Rate