Abstract Nearly 50% patients with head and neck cancer after radiotherapy will recurrence in the previous radiation fields. Salvage surgery is the first choice of treatment. Clinical studies have shown that a small number of patients with recurrent head and neck cancer can benefit from salvage surgery plus postoperative re-irradiation or re-irradiation with or without chemotherapy or targeted therapy,and these patients can achieved tumor control and long-term survival. However, the overall efficacy is not satisfactory, and often accompanied by severe acute and late, and even fatal treatment-related toxicity. Therefore, it is necessary to give full consideration to the condition of recurrent tumor, the first radiotherapy related factors and the patient′s related status before implementation of re-irradiation. The development of radiotherapy technology and comprehensive treatment, including the clinical application of proton and heavy ion and immune therapy, provides the possibility of improving the prognosis and reducing treatment-related toxicity for these patients.
[1] Lang JY,Gao L,Guo Y,et al. Comprehensive treatment of squamous cell cancer of head and neck:Chinese expert consensus 2013[J].Future Oncol,2014,10(9):1635-1648.DOI:10.2217/fon.14.44. [2] Forastiere AA,Goepfert H,Maor M,et al. Concurrent chemotherapy and radiotherapy for organ preservation in advanced laryngeal cancer[J].N Engl J Med,2003,349(22):2091-2098.DOI:10.1056/NEJMoa031317. [3] Calais G,Bardet E,Sire C,et al. Radiotherapy with concomitant weekly docetaxel for Stages Ⅲ/Ⅳ oropharynx carcinoma. Results of the 98-02 GORTEC Phase Ⅱ trial[J].Int J Radiat Oncol Biol Phys,2004,58(1):161-166.DOI:10.1016/S0360-3016(03)01370-1. [4] Taussky D,Dulguerov P,Allal AS.Salvage surgery after radical accelerated radiotherapy with concomitant boost technique for head and neck carcinomas[J].Head Neck,2005,27(3):182-186.DOI:10.1002/hed.20139. [5] Temam S,Pape E,Janot F,et al. Salvage surgery after failure of very accelerated radiotherapy in advanced head-and-neck squamous cell carcinoma[J].Int J Radiat Oncol Biol Phys,2005,62(4):1078-1083.DOI:10.1016/j.ijrobp.2004.12.062. [6] Goodwin WJ Jr. Salvage surgery for patients with recurrent squamous cell carcinoma of the upper aerodigestive tract:when do the ends justify the means?[J].Laryngoscope,2000,110(S93):1-18.DOI:10.1097/00005537-200003001-00001. [7] De Crevoisier R,Bourhis J,Domenge C,et al. Full-dose reirradiation for unresectable head and neck carcinoma:experience at the Gustave-Roussy Institute in a series of 169 patients[J].J Clin Oncol,1998,16(11):3556-3562.DOI:10.1200/JCO.1998.16.11.3556. [8] Janot F,de Raucourt D,Benhamou E,et al. Randomized trial of postoperative reirradiation combined with chemotherapy after salvage surgery compared with salvage surgery alone in head and neck carcinoma[J].J Clin Oncol,2008,26(34):5518-5523.DOI:10.1200/JCO.2007.15.0102. [9] Wong SJ,Heron DE,Stenson K,et al. Locoregional recurrent or second primary head and neck cancer:management strategies and challenges[J].Am Soc Clin Oncol Educ Book,2016,35:e284-e292.DOI:10.14694/EDBK_157804. [10] Davis KS,Vargo JA,Ferris RL,et al. Stereotactic body radiotherapy for recurrent oropharyngeal cancer-influence of HPV status and smoking history[J].Oral Oncol,2014,50(11):1104-1108.DOI:10.1016/j.oraloncology.2014.08.004. [11] Duprez F,Madani I,Bonte K,et al. Intensity-modulated radiotherapy for recurrent and second primary head and neck cancer in previously irradiated territory[J].Radiother Oncol,2009,93(3):563-569.DOI:10.1016/j.radonc.2009.10.012. [12] Spencer SA,Harris J,Wheeler RH,et al. Final report of RTOG 9610,a multi-institutional trial of reirradiation and chemotherapy for unresectable recurrent squamous cell carcinoma of the head and neck[J].Head Neck,2008,30(3):281-288.DOI:10.1002/hed.20697. [13] McDonald MW,Moore MG,Johnstone PAS.Risk of carotid blowout after reirradiation of the head and neck:a systematic review[J].Int J Radiat Oncol Biol Phys,2012,82(3):1083-1089.DOI:10.1016/j.ijrobp.2010.08.029. [14] Tanvetyanon T,Padhya T,McCaffrey J,et al. Prognostic factors for survival after salvage reirradiation of head and neck cancer[J].J Clin Oncol,2009,27(12):1983-1991.DOI:10.1200/JCO.2008.20.0691. [15] McDonald MW,Lawson J,Garg MK,et al. ACR appropriateness criteria retreatment of recurrent head and neck cancer after prior definitive radiation:expert panel on radiation oncology-head and neck cancer[J].Int J Radiat Oncol Biol Phys, 2011,80(5):1292-1298.DOI:10.1016/j.ijrobp.2011.02.014. [16] Strojan P,Corry J,Eisbruch A,et al. Recurrent and second primary squamous cell carcinoma of the head and neck:when and how to reirradiate[J].Head Neck,2015,37(1):134-150.DOI:10.1002/hed.23542. [17] Popovtzer A,Gluck I,Chepeha DB,et al. The pattern of failure after reirradiation of recurrent squamous cell head and neck cancer:implications for defining the targets[J].Int J Radiat Oncol Biol Phys,2009,74(5):1342-1347.DOI:10.1016/j.ijrobp.2008.10.042. [18] Lee N,Chan K,Bekelman JE,et al. Salvage re-irradiation for recurrent head and neck cancer[J].Int J Radiat Oncol Biol Phys,2007,68(3):731-740.DOI:10.1016/j.ijrobp.2006.12.055. [19] Duprez F,Berwouts D,Madani I,et al. High-dose reirradiation with intensity-modulated radiotherapy for recurrent head-and-neck cancer:disease control,survival and toxicity[J].Radiother Oncol,2014,111(3):388-392.DOI:10.1016/j.radonc.2014.04.018. [20] Rwigema JCM,Heron DE,Ferris RL,et al. The impact of tumor volume and radiotherapy dose on outcome in previously irradiated recurrent squamous cell carcinoma of the head and neck treated with stereotactic body radiation therapy[J].Am J Clin Oncol,2011,34(4):372-379.DOI:10.1097/COC.0b013e3181e84 dc0. [21] Voynov G,Heron DE,Burton S,et al. Frameless stereotactic radiosurgery for recurrent head and neck carcinoma[J].Technol Cancer Res Treat,2006,5(5):529-535.DOI:10.1177/153303460600500510. [22] Unger KR,Lominska CE,Deeken JF,et al. Fractionated stereotactic radiosurgery for reirradiation of head-and-neck cancer[J].Int J Radiat Oncol Biol Phys,2010,77(5):1411-1419.DOI:10.1016/j.ijrobp.2009.06.070. [23] Wong SJ,Bourhis J,Langer CJ.Retreatment of recurrent head and neck cancer in a previously irradiated field[J].Semin Radiat Oncol,2012,22(3):214-219.DOI:10.1016/j.semradonc.2012.03.006. [24] Romesser PB,Cahlon O,Scher ED,et al. Proton beam reirradiation for recurrent head and neck cancer:multi-institutional report on feasibility and early outcomes[J].Int J Radiat Oncol Biol Phys,2016,95(1):386-395.DOI:10.1016/j.ijrobp.2016.02.036. [25] Phan J,Sio TT,Nguyen TP,et al. Reirradiation of head and neck cancers with proton therapy:outcomes and analyses[J].Int J Radiat Oncol Biol Phys,2016,96(1):30-41.DOI:10.1016/j.ijrobp.2016.03.053. [26] Salama JK,Vokes EE,Chmura SJ,et al. Long-term outcome of concurrent chemotherapy and reirradiation for recurrent and second primary head-and-neck squamous cell carcinoma[J].Int J Radiat Oncol Biol Phys,2006,64(2):382-391.DOI:10.1016/j.ijrobp.2005.07.005. [27] Langer CJ,Harris J,Horwitz EM,et al. Phase Ⅱ study of low-dose paclitaxel and cisplatin in combination with split-course concomitant twice-daily reirradiation in recurrent squamous cell carcinoma of the head and neck:results of Radiation Therapy Oncology Group Protocol 9911[J].J Clin Oncol,2007,25(30):4800-4805.DOI:10.1200/JCO.2006.07.9194. [28] Comet B,Kramar A,Faivre-Pierret M,et al. Salvage stereotactic reirradiation with or without cetuximab for locally recurrent head-and-neck cancer:a feasibility study[J].Int J Radiat Oncol Biol Phys,2012,84(1):203-209.DOI:10.1016/j.ijrobp.2011.11.054. [29] Vargo JA,Ferris RL,Ohr J,et al. A prospective phase 2 trial of reirradiation with stereotactic body radiation therapy plus cetuximab in patients with previously irradiated recurrent squamous cell carcinoma of the head and neck[J].Int J Radiat Oncol Biol Phys,2015,91(3):480-488.DOI:10.1016/j.ijrobp.2014.11.023. [30] Seiwert TY,Burtness B,Mehra R,et al. Safety and clinical activity of pembrolizumab for treatment of recurrent or metastatic squamous cell carcinoma of the head and neck (KEYNOTE-012):an open-label,multicentre,phase 1b trial[J].Lancet Oncol,2016,17(7):956-965.DOI:10.1016/S1470-2045(16)30066-3. [31] Formenti SC,Demaria S.Combining radiotherapy and cancer immunotherapy:a paradigm shift[J].J Natl Cancer Inst,2013,105(4):256-265.DOI:10.1093/jnci/djs629. [32] Victor CTS,Rech AJ,Maity A,et al. Radiation and dual checkpoint blockade activate non-redundant immune mechanisms in cancer[J].Nature,2015,520(7547):373-377.DOI:10.1038/nature14292. [33] Barker HE,Paget JTE,Khan AA,et al. The tumour microenvironment after radiotherapy:mechanisms of resistance and recurrence[J].Nat Rev Cancer,2015,15(7):409-425.DOI:10.1038/nrc3958.
2017, Vol. 26 
