title: Locoregional Recurrent or Second Primary Head and Neck Cancer: Management Strategies and Challenges.
abstract: Treatment of patients with locoregional recurrent or second primary head and neck squamous cell cancer (HNSCC) has been guided by well-reasoned principles and informed by carefully tested chemotherapy and radiation regimens. However, clinical decision making for this population is complicated by many factors. Although surgery is generally considered the treatment of choice for patients with HNSCC with recurrent disease or new second primary disease in a previously irradiated field, operability of cases is not always straightforward. Postoperative treatment is frequently warranted but carries significant risk. In addition, the rapid rise in the incidence of HPV-associated HNSCC raises the question of whether established treatment paradigms should be re-examined in this population of patients with a much better prognosis than the non-HPV population. Furthermore, new radiation techniques and new systemic agents show early promising results in recent clinical studies, suggesting potential for practice-changing effects in the future management of this disease. This article examines each of the treatment modalities used in the care of patients with HNSCC with recurrent or new second primary disease and provides a perspective to aid clinicians in the management of this disease.
authors.affiliation: From the University of Pittsburgh Cancer Institute, Pittsburgh, PA; University of Pittsburgh School of Medicine, Pittsburgh, PA; Rush University Medical Center, Chicago, IL; Medical College of Wisconsin, Milwaukee, WI.
authors.forename: Stuart J
authors.initials: SJ
authors.lastname: Wong
authors.affiliation: From the University of Pittsburgh Cancer Institute, Pittsburgh, PA; University of Pittsburgh School of Medicine, Pittsburgh, PA; Rush University Medical Center, Chicago, IL; Medical College of Wisconsin, Milwaukee, WI.
authors.forename: Dwight E
authors.initials: DE
authors.lastname: Heron
authors.affiliation: From the University of Pittsburgh Cancer Institute, Pittsburgh, PA; University of Pittsburgh School of Medicine, Pittsburgh, PA; Rush University Medical Center, Chicago, IL; Medical College of Wisconsin, Milwaukee, WI.
authors.forename: Kerstin
authors.initials: K
authors.lastname: Stenson
authors.affiliation: From the University of Pittsburgh Cancer Institute, Pittsburgh, PA; University of Pittsburgh School of Medicine, Pittsburgh, PA; Rush University Medical Center, Chicago, IL; Medical College of Wisconsin, Milwaukee, WI.
authors.forename: Diane C
authors.initials: DC
authors.lastname: Ling
authors.affiliation: From the University of Pittsburgh Cancer Institute, Pittsburgh, PA; University of Pittsburgh School of Medicine, Pittsburgh, PA; Rush University Medical Center, Chicago, IL; Medical College of Wisconsin, Milwaukee, WI.
authors.forename: John A
authors.initials: JA
authors.lastname: Vargo
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery*; D003131:Combined Modality Therapy; D019468:Disease Management; D006258:Head and Neck Neoplasms / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery*; D006801:Humans; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery*; D016609:Neoplasms, Second Primary / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery*; D011379:Prognosis; D000077195:Squamous Cell Carcinoma of Head and Neck
chemical_list: D000970:Antineoplastic Agents