New Guidelines for Head & Neck Cancer Reirradiation

Recurrent and second primary head-and-neck squamous cell carcinomas (HNSCC) arising within or close to previously irradiated areas are a significant clinical challenge. Salvage surgical resection is the standard of care, but reirradiation is the only potentially curative treatment when surgery is not an option. Reirradiation is more challenging than initial treatment because of the side effects of prior therapy and concerns about the risks of high cumulative radiation doses to normal structures. Multi-institutional trials and large single institutional experiences have demonstrated that aggressive reirradiation, most often with chemotherapy, is feasible and provides durable locoregional control in some patients. An Expert Consensus on Reirradiation In the August 1, 2011 International Journal of Radiation Oncology * Biology * Physics, the American College of Radiology (ACR) published appropriateness criteria for recurrent head and neck cancer after prior definitive radiation. The ACR expert panel recommended that patient evaluation and reirradiation for HNSCC be performed at a tertiary care center with a head and neck oncology team that is equipped with the resources and experience to manage the complexities and toxicities of retreatment. Evaluation of Patients with Head & Neck Cancer Patient evaluation is important in assuring only appropriate patients are offered reirradiation. Evaluation should include careful restaging imaging, a detailed history and assessment of life expectancy, access to the prior radiotherapy details, and evaluation of: Comorbidities. Performance status. Speech and swallowing function. Sequelae of previous treatment (eg, fibrosis, carotid stenosis, osteoradionecrosis, or other severe toxicity). The ACR recommends that patients with a reasonable performance status who do not have severe soft tissue or bone toxicities from prior therapy and do not have distant...