Retreatment of recurrent head and neck cancer in a previously irradiated field

During the past 2 decades, concurrent chemotherapy with reirradiation (reRT) has matured from a fear-provoking, rarely performed therapeutic strategy to an accepted mainstream option for selected patients with recurrent or second primary squamous cell head and neck cancer in previously irradiated fields. Attempts by investigators to advance and improve reRT have included multiple new approaches, such as the use of reRT in the postoperative setting, the integration of new radiation techniques, as well as the addition of targeted agents into reRT regimens. We review and discuss recent studies that address these areas. Although clinical research efforts to examine new reRT regimens are valuable, we have reached a plateau in the acquisition of significant new knowledge because of a paucity of prospective multicenter studies and a near total absence of randomized phase III trials. Analysis of recent reRT studies points out areas where incremental advances have been made, but more importantly, we provide a guide to the priorities on which future investigations should focus.