[Treatment for recurrent head and neck carcinomas]

In head and neck carcinomas, over 50% of patients present with advanced local and regional disease. Despite curative treatments of radiotherapy and/or surgery for these advanced cases, locoregional control remains a significant problem with locoregional recurrences in up to 50-60% of cases. The prognosis of cases who relapse in the early period after their primary therapy, is poor, because of the poor response to chemotherapy and/or radiation therapy. Furthermore, metastatic recurrences in distant organs and second primaries are other medical problems. Chemotherapy is a key treatment in the management of locally recurrent patients during the early period after curative radiotherapy in primary therapy. Recently, chemotherapy including CDDP has been applied for locally recurrent patients. The response rate or chemotherapy, however, is low with a short duration time. The recent studies in terms of reirradiation for patients with locoregional recurrences were reviewed. Because of radiation therapy given in the primary therapy, reirradiation combined with chemotherapy (chemoradiation) has been used to improve the efficacy and to reduce the cumulative dose of reirradiation. Chemoradiation consisting of efficacious chemotherapy and a radiation dose of about 60 Gy is important to improve local control and survival of recurrent cases of head and neck carcinomas.