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.