title: Hyperfractionated stereotactic reirradiation for recurrent head and neck cancer.
abstract: OBJECTIVE
  The goal of this work was to evaluate the efficacy and toxicity of hyperfractionated stereotactic reirradiation (re-RT) as a treatment for inoperable, recurrent, or second primary head and neck squamous cell cancer (HNSCC) that is not suitable for systemic treatment.
  
  
  METHODS
  Forty patients with recurrent or second primary HNSCC were included in this study. The patients had a median gross tumor volume of 76 ml (range 14-193 ml) and a previous radiotherapy dose greater than 60 Gy. Treatment was designed to cover 95 % of the planning target volume (PTV, defined as gross tumor volume [GTV] + 3 mm to account for microscopic spreading, with no additional set-up margin) with the prescribed dose (48 Gy in 16 fractions b.i.d.). Treatment was administered twice daily with a minimum 6 h gap. Uninvolved lymph nodes were not irradiated.
  
  
  RESULTS
  Treatment was completed as planned for all patients (with median duration of 11 days, range 9-14 days). Acute toxicity was evaluated using the RTOG/EORTC scale. A 37 % incidence of grade 3 mucositis was observed, with recovery time of ≤ 4 weeks for all of these patients. Acute skin toxicity was never observed to be higher than grade 2. Late toxicity was also evaluated according to the RTOG/EORTC scale. Mandible radionecrosis was seen in 4 cases (10 %); however, neither carotid blowout syndrome nor other grade 4 late toxicity occurred. One-year overall survival (OS) and local progression-free survival (L-PFS) were found to be 33 and 44 %, respectively. Performance status and GTV proved to be significant prognostic factors regarding local control and survival.
  
  
  CONCLUSIONS
  Hyperfractionated stereotactic re-RT is a reasonable treatment option for patients with recurrent/second primary HNSCC who were previously exposed to high-dose irradiation and who are not candidates for systemic treatment or hypofractionation.
authors: Department of Oncology, University Hospital Ostrava, listopadu 1790, 708 52, Ostrava, Czech Republic. jakub.cvek@fno.cz.
authors: Jakub
authors: J
authors: Cvek
authors: Department of Oncology, University Hospital Ostrava, listopadu 1790, 708 52, Ostrava, Czech Republic.
authors: Lukas
authors: L
authors: Knybel
authors: Department of Oncology, University Hospital Ostrava, listopadu 1790, 708 52, Ostrava, Czech Republic.
authors: Eva
authors: E
authors: Skacelikova
authors: Department of Maxilofacial Surgery, University Hospital Ostrava, Ostrava, Czech Republic.
authors: Jiri
authors: J
authors: Stransky
authors: Department of Otolaryngology, University Hospital Ostrava, Ostrava, Czech Republic.
authors: Petr
authors: P
authors: Matousek
authors: Department of Otolaryngology, University Hospital Ostrava, Ostrava, Czech Republic.
authors: Karol
authors: K
authors: Zelenik
authors: Department of Maxilofacial Surgery, University Hospital Ostrava, Ostrava, Czech Republic.
authors: Oldrich
authors: O
authors: Res
authors: Department of Oncology, University Hospital Ostrava, listopadu 1790, 708 52, Ostrava, Czech Republic.
authors: Bretislav
authors: B
authors: Otahal
authors: Department of Oncology, University Hospital Ostrava, listopadu 1790, 708 52, Ostrava, Czech Republic.
authors: Lukas
authors: L
authors: Molenda
authors: Department of Oncology, University Hospital Ostrava, listopadu 1790, 708 52, Ostrava, Czech Republic.
authors: David
authors: D
authors: Feltl
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000601:surgery*; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000601:surgery*; D009367:Neoplasm Staging; D016609:Neoplasms, Second Primary / Q000473:pathology / Q000601:surgery*; D010039:Otorhinolaryngologic Neoplasms / Q000473:pathology / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology; D016634:Radiosurgery / Q000379:methods*; D019233:Retreatment; D015996:Survival Rate
keywords: Overall survival; Reirradiation; Squamous cell carcinoma of the head and neck; Stereotactic radiotherapy; Toxicity