Background: Patients with previously irradiated, recurrent head and neck cancer or second primary tumors arising in a previously irradiated field present a therapeutic dilemma. Salvage surgery with complete microscopic (R0) resection is the standard of care but can be performed in only a minority of cases. The use of adjuvant reirradiation after salvage surgery remains a controversial issue. A Phase III trial of observation vs. combined chemo-reirradiation achieved improved locoregional control after combined modality therapy but had no effect on survival (Janot et al., 2008). Adjuvant reirradiation using non-standard radiation modalities such as adjuvant LDR (Khan et al., 2019), PDR (Strnad et al., 2003), or HDR brachytherapy (Martinez-Fernandez et al., 2017)have the potential to decrease adverse events while retaining local control rates because these approaches require smaller treatment volumes (Figure 1).
Purpose/Objective: To discuss the rationale, technicalities, patient selection, treatment schedules, dosimetric guidelines and results of reirradiation with adjuvant brachytherapy in previously irradiated, recurrent head and neck cancer or second primary tumors arising in a previously irradiated field.
Material/Methods: Update of well-designed and mature clinical trials with enough sample size. All types of brachytherapy trials (i.e, LDR, HDR, permanent brachytherapy,etc.) pertaining to the above category will be considered. Considerations for boosting the scope of adjuvant brachytherapy as a must in the armamentarium of recurrent head and neck cancer.
Results: Data from clinical trials will be structured into three main sections: a) Toxicity, b) Locoregional Control and c) Survival. The main learning objective of the toxicity section is to provide an understanding of the risk of soft tissue necrosis (STN) and bone necrosis (BN) in head and neck brachytherapy as well as to provide recommendations to minimize their occurrence. Locoregional control and survival at 2 and 5 years will be provided with emphasis on patient selection.
Conclusions: Surgical resection and adjuvant is a successful treatment strategy in selected patients with previously irradiated head and neck cancer. Long-term locoregional control and cure can be achieved in a substantial number of cases despite a high rate inadequate surgical resections although at the expense of a substantial toxicity.