REIRRADIATION OF RECURRENT HEAD AND NECK CANCERS - EXTERNAL AND/OR INTERSTITIAL RADIATION-THERAPY

Recurrent cancer in the head and neck is not an uncommon clinical problem. The average cure rate of these patients has been reported to vary between 30 and 40% and most failures are due to locoregional relapses. After a previous full course of radiation, surgery is the salvage modality of choice; however, if surgery was not feasible for whatever reason, reirradiation has been offered to some patients. To establish the role of reirradiation in head and neck cancer, we analyzed a 13-year experience with patients reirradiated in the DDHCC. The reirradiation was performed between 1970 and 1980 by means of external beam radiation therapy (ERT series; n = 55) and between 1985 and 1988 by external radiation combined with interstitial radiation therapy (IRT +/- ERT series; n = 18). A minimum follow-up of 3 years was allowed for. An improvement in local control was observed (50% vs. 29%) for the IRT +/- ERT series and the ERT series, respectively. The improvement in local control was not reflected in a survival benefit; i.e. an actuarial overall survival of 20% at 5 years was observed in both series. No treatment-related deaths occurred. However, for the patients that were controlled at the reirradiated site, 28% (4/16 of the ERT series and 3/9 of the IRT +/- ERT series) did experience severe side effects.