title: Reirradiation for recurrent head and neck carcinoma.
abstract: OBJECTIVE
  To present the outcome and toxicity profile of reirradiation (re-RT) in patients with recurrent head and neck cancer (HNC).
  
  
  METHODS
  From 1995 to 2009, 35 patients underwent re-RT at our institution. Twenty-seven (77%) patients were initially diagnosed with stage III/IV disease. The median total doses of irradiation -first and second courses- were 66.0 Gy (range 54.0-70.0) and 55.8 Gy (range 32.5-66.6), respectively. The median time from the first course of irradiation to re-RT was 25.2 months (range 8-136). Six (17%) patients underwent salvage surgery before reirradiation. Concurrent chemotherapy was administered to 18 (51%) patients.
  
  
  RESULTS
  With a median follow-up of 12.9 months (range 2.5-109.6), the 1- and 2-year locoregional control (LRC) rates were 41 and 9%, respectively. The 1- and 2-year disease free survival (DFS) rates were 30 and 7%, respectively. The 1- and 2-year overall survival (OS) rates were 42.9 and 7.9%, respectively. Grade 3 acute toxicity was reported in 7 (20%) patients while grade 3-4 late radiation-induced complications were seen in 8 (23%) patients. In univariate analysis, an improvement in OS was observed in patients with initial N0/N1 stage vs. those with N2/N3 stage (p=0.004). Prior neoadjuvant chemotherapy was associated with significantly inferior OS (p=0.028), while neoadjuvant chemotherapy in recurrence was predictive of improved LRC (p=0.041).
  
  
  CONCLUSIONS
  re-RT in HN cancer is associated with poor prognosis, especially in patients with inoperable disease. Complications due to treatment are not infrequent. Nonetheless, our outcomes remain encouraging and applicable to a carefully selected patient population.
authors.affiliation: Department of Radiation Oncology, University Hospital of Ioannina, Ioannina, Greece. vagelita@yahoo.com
authors.forename: E
authors.initials: E
authors.lastname: Peponi
authors.forename: S
authors.initials: S
authors.lastname: Balta
authors.forename: I
authors.initials: I
authors.lastname: Tasiou
authors.forename: P
authors.initials: P
authors.lastname: Gogou
authors.forename: A
authors.initials: A
authors.lastname: Capizzello
authors.forename: E
authors.initials: E
authors.lastname: Pitouli
authors.forename: P
authors.initials: P
authors.lastname: Tsekeris
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006258:Head and Neck Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D006801:Humans; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D009367:Neoplasm Staging