Reirradiation of recurrent tumors in the head and neck

From 1971 to 1980, 55 patients were reirradiated in the Dr. Daniel den Hoed Kliniek for a recurrent cancer in the head and neck. For all patients considered, the primary treatment consisted of full course radiation therapy (RT) only; the recurrent tumors were irradiated with external and/or interstitial radiation therapy. In some of these patients, the reirradiation was combined with surgery and/or chemotherapy. A poor overall survival was found, i.e., after 5 years only 20% of the patients are still alive. Although the patients with a recurrent tumor of the nasopharynx seem to fare slightly better, no statistically significant difference was found for the different sites in the head and neck. A trend towards a somewhat better survival was observed for subsets of patients for whom either the reirradiation was combined with surgery or for whom the time period elapsed between the primary treatment and the initiation of the second irradiation was more than 12 months. Moreover, best local control was seen in recurrent tumors reirradiated by high doses of RT; i.e., with 50 Gy or more, a local control rate of 48% was obtained. Future treatment strategies towards a better local control and survival are discussed.