Introduction: Loco-regional failures, recurrence or second primary after radiotherapy (RT) is a significant problem in head and neck cancer (HNC) and represent a challenge. Methods: 39 patients were referred to the Radiation Oncology Department, A. C. Camargo Cancer Center, Sao Paulo, Brazil between 2007 to 2012 to have a second new course of RT (Re-RT) to a previous irradiated area in the head and neck. Results: Median age of patients was 53.8 (range, 31-74) years. Twenty four (61.5%) patients had surgery and Re-RT. The first radiation course dose ranged from 45 Gy to 72 Gy (median 60.0 Gy) and the median interval between the initial and second radiation course was 32 (range, 9-146) months. The median follow-up was 2.6 (range, 0.5-5.9) years. The 2- and 5-year actuarial OS, PFS and LC rates were 76.0%, 38.6%, 83.8%, 75.0%, 27.0% and 14.0%, respectively. Re-RT with IMRT when compared to other techniques showed PFS and LC advantages, p= 0.018 and p=0.019, respectively, confirmed by Cox regression multivariate - HR=6.08 (p= 0.020, 95% CI: 1.331- 27.767). Major toxicity occurred in 14 (35.9%) patients and eye observed no carotid artery blowout in this series. Conclusion: Re-RT should be offered for patients who are not suitable for surgery or for those with marginal resections, with a clear understanding that survival is poor and many of these patients will suffer severe radiation-related insults to their quality of life, during and after treatment.
This study contributes in the existing literature by analyzing the impact of new technologies in the local control of recurrent head and neck cancer.
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