Reirradiation of patients with recurrent or second primary carcinoma of the head and neck
Abstract
Background: The majority of patients with head and neck squamous cell carcinoma presents with locally advanced disease, which requires combined treatment that often includes irradiation. Despite aggressive treatment, many patients develop recurrent or second primary carcinoma in previously irradiated area. For these patients, re-irradiation alone or in combination with salvage surgery, with or without systemic treatment, is often the only potentially curative treatment. However, because of high cumulative irradiation doses, re-irradiation is associated with serious late complications.
Case report: Presented are two clinical cases which were irradiated for tongue and vocal cord squamous cell carcinoma, respectively. After eleven and seven years, respectively, they were both treated for second primary squamous cell carcinoma of the oropharynx. First patient was treated with induction chemotherapy followed by surgery and postoperative chemoradiotherapy, while the second patient was treated solely with induction chemotherapy and chemoradiation. Twenty-one and 34 months after completion of treatment, both patients are without signs of local disease and with acceptable late toxicities.
Conclusions: For patients with recurrent or second primary head and neck carcinoma in previously irradiated area therapeutic options are scanty. Re-irradiation alone or in combination with salvage surgery, with or without systemic treatment, offers to some patients chance of long-term local control, but is associated with serious late side-effects. Proper selection of patients suitable for such treatment is of paramount importance.
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