title: Re-irradiation of unresectable recurrent head and neck cancer: using Helical Tomotherapy as image-guided intensity-modulated radiotherapy.
abstract: OBJECTIVE
  Re-irradiation (re-RT) is considered a treatment option for inoperable locoregionally recurrent head and neck cancer (HNC) after prior radiotherapy. We evaluated the efficacy and safety of re-RT using Helical Tomotherapy as image-guided intensity-modulated radiotherapy in recurrent HNC.
  
  
  METHODS
  Patients diagnosed with recurrent HNC and received re-RT were retrospectively reviewed. Primary endpoint was overall survival (OS) and secondary endpoints were locoregional control and toxicities.
  
  
  RESULTS
  The median follow-up period of total 9 patients was 18.7 months (range, 4.1 to 76 months) and that of 3 alive patients was 49 months (range, 47 to 76 months). Median dose of first radiotherapy and re-RT was 64.8 and 47.5 Gy10. Median cumulative dose of the two courses of radiotherapy was 116.3 Gy10 (range, 91.8 to 128.9 Gy10) while the median interval between the two courses of radiation was 25 months (range, 4 to 137 months). The response rate after re-RT of the evaluated 8 patients was 75% (complete response, 4; partial response, 2). Median locoregional relapse-free survival after re-RT was 11.9 months (range, 3.4 to 75.1 months) and 5 patients eventually presented with treatment failure (in-field failure, 2; in- and out-field failure, 2; out-field failure, 1). Median OS of the 8 patients was 20.3 months (range, 4.1 to 75.1 months). One- and two-year OS rates were 62.5% and 50%, respectively. Grade 3 leucopenia developed in one patient as acute toxicity, and grade 2 osteonecrosis and trismus as chronic toxicity in another patient.
  
  
  CONCLUSIONS
  Re-RT using Helical Tomotherapy for previously irradiated patients with unresectable locoregionally recurrent HNC may be a feasible treatment option with long-term survival and acceptable toxicities.
authors: Department of Radiation Oncology, The Catholic University of Korea College of Medicine, Seoul, Korea.
authors: Songmi
authors: S
authors: Jeong
authors: Department of Radiation Oncology, The Catholic University of Korea College of Medicine, Seoul, Korea.
authors: Eun Jung
authors: EJ
authors: Yoo
authors: Department of Radiation Oncology, The Catholic University of Korea College of Medicine, Seoul, Korea.
authors: Ji Yoon
authors: JY
authors: Kim
authors: Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea.
authors: Chi Wha
authors: CW
authors: Han
authors: Department of Diagnostic Radiology, The Catholic University of Korea College of Medicine, Seoul, Korea.
authors: Ki Jun
authors: KJ
authors: Kim
authors: Department of Radiation Oncology, The Catholic University of Korea College of Medicine, Seoul, Korea.
authors: Chul Seung
authors: CS
authors: Kay
keywords: Helical Tomotherapy; IG-IMRT; Image-guided radiation therapy; Intensity-modulated radiotherapy; Re-RT; Recurrent head and neck cancer