Outcomes of reirradiation for recurrent head and neck SCC
Reviewed by Christopher Burgess

Recurrent squamous cell carcinoma of the head and neck is often a challenge to manage when radiotherapy has previously been administered as a component of the initial treatment. Salvage surgery is usually the preferred modality of treatment, but for unresectable disease or adverse histological features following salvage surgery, consideration can be given to further radiotherapy in some circumstances. This paper reviewed the outcomes of 54 patients treated with reirradiation in a tertiary centre in the USA from January 1998 to January 2024. The average age of the cohort was 62.7 years. Reirradiation was mainly for local or regional recurrence (88.9%) and delivered following salvage surgery in approximately two thirds (68.5%) of cases. Positive surgical margins were present in 29.4% and extracapsular spread in 59.5%. Exactly half the cohort (27 patients) were alive at follow-up, with a median follow-up period of 52.6 months. Two-year loco-regional control, disease-free survival and overall survival rates were 58.2%, 53.0% and 74.6% respectively. Lymphovascular invasion was significantly correlated with overall survival, while the initial tumour T-stage and neck disease involvement were linked to loco-regional control. One of the key concerns with reirradiation is the toxicity of this treatment. In keeping with this, the proportion of gastrostomy-dependent patients increased from just under a quarter (24%) before reirradiation to two thirds (67%) following reirradiation. Five patients (9%) were tracheostomy-dependent before reirradiation, 25 (46%) were tracheostomy-dependent post irradiation. This paper provides further useful data regarding the potential survival benefits associated with reirradiation. These benefits have to be carefully weighed against the significant morbidity associated with this treatment, including a high chance of being gastrostomy and / or tracheostomy-dependent in the aftermath.

Reirradiation in head and neck squamous cell carcinoma; prognostic indicators, oncologic and functional outcomes.
Slater NN, Farsi S, Rogers AL, et al.
AM J OTOLARYNGOL
2024;45(6):104482.