title: ACR appropriateness criteria retreatment of recurrent head and neck cancer after prior definitive radiation expert panel on radiation oncology-head and neck cancer.
abstract: Recurrent and second primary head-and-neck squamous cell carcinomas arising within or in close proximity to previously irradiated fields are a common clinical challenge. Whereas surgical salvage therapy is recommended for resectable disease, randomized data support the role of postoperative reirradiation in high-risk patients. Definitive reirradiation is an established approach for patients with recurrent disease who are medically or technically inoperable or decline radical surgery. The American College of Radiology Expert Panel on Head and Neck Cancer reviewed the relevant literature addressing re-treatment after prior definitive radiation and developed appropriateness criteria for representative clinical scenarios. Examples of unresectable recurrent disease and microscopic residual disease after salvage surgery were addressed. The panel evaluated the appropriateness of reirradiation, the integration of concurrent chemotherapy, radiation technique, treatment volume, dose, and fractionation. The panel emphasized the importance of patient selection and recommended evaluation and treatment at tertiary-care centers with a head-and-neck oncology team equipped with the resources and experience to manage the complexities and toxicities of re-treatment.
authors.affiliation: Indiana University School of Medicine, Indianapolis, Indiana. mwmcdona@iupui.edu
authors.forename: Mark W
authors.initials: MW
authors.lastname: McDonald
authors.forename: Joshua
authors.initials: J
authors.lastname: Lawson
authors.forename: Madhur Kumar
authors.initials: MK
authors.lastname: Garg
authors.forename: Harry
authors.initials: H
authors.lastname: Quon
authors.forename: John A
authors.initials: JA
authors.lastname: Ridge
authors.forename: Nabil
authors.initials: N
authors.lastname: Saba
authors.forename: Joseph K
authors.initials: JK
authors.lastname: Salama
authors.forename: Richard V
authors.initials: RV
authors.lastname: Smith
authors.forename: Anamaria Reyna
authors.initials: AR
authors.lastname: Yeung
authors.forename: Sue S
authors.initials: SS
authors.lastname: Yom
authors.forename: Jonathan J
authors.initials: JJ
authors.lastname: Beitler
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002173:Cancer Care Facilities / Q000592:standards; D002277:Carcinoma / Q000188:drug therapy / Q000532:radiotherapy* / Q000601:surgery; D002294:Carcinoma, Squamous Cell; D005260:Female; D006258:Head and Neck Neoplasms / Q000188:drug therapy / Q000532:radiotherapy* / Q000601:surgery; D006801:Humans; D008297:Male; D009303:Nasopharyngeal Neoplasms / Q000532:radiotherapy / Q000601:surgery; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy / Q000532:radiotherapy* / Q000601:surgery; D018365:Neoplasm, Residual; D016609:Neoplasms, Second Primary / Q000188:drug therapy / Q000532:radiotherapy* / Q000601:surgery; D018307:Neoplasms, Squamous Cell / Q000188:drug therapy / Q000532:radiotherapy* / Q000601:surgery; D058958:Organs at Risk / Q000528:radiation effects; D018579:Patient Selection; D018787:Radiation Oncology / Q000592:standards; D011836:Radiation Tolerance; D019233:Retreatment / Q000592:standards; D016879:Salvage Therapy / Q000379:methods; D000077195:Squamous Cell Carcinoma of Head and Neck; D014481:United States