الفهرس 
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Abstract
Summary
Patients presenting with recurrent head and neck
cancer in a previously irradiated field present a therapeutic
challenge. Salvage surgery, if feasible, represents the
preferred treatment option. Reirradiation with or without
chemotherapy has become an accepted alternative to
chemotherapy or supportive care in unresectable disease
and may offer long-term survival for selected patients.
The role of re-irradiation in the treatment of recurrent
and new primary cancer of the head and neck is
controversial. Although historically avoided owing to
concerns of serious complications, several reports have
demonstrated that re-irradiation is feasible and effective in
carefully selected patients using a variety of techniques and
fractionation schedules. However, multiple unanswered
questions persist regarding the appropriate selection criteria
and therapeutic decision making. Although recent data are
encouraging, the heterogeneity of the published trials with
respect to the selection criteria and treatment details make
drawing conclusions challenging. Decisions regarding reirradiation
to the head and neck must be carefully
individualized considering the plethora of practical issues.
It is also likely that with additional advances in technology
Summary and Recommendations
٢٢٥
and continued understanding of the normal tissue and
tumor responses to radiation, the patterns of care will
continue to evolve (Allen et al., ٢٠١١).
More importantly, the results indicate that
postoperative chemo-re-irradiation significantly improves
loco-regional tumour control among patients at risk for a
second failure. Therefore, postoperative (chemo-) reirradiation
should be considered in these cases, in particular
given the very low locoregional control rate after salvage
surgery alone which was only ٢٠٪ at ٢ years. However, in
the light of the high rate of late toxicity, the exact
postoperative regimen in the re-irradiation setting requires
further optimization, e.g., by optimizing the fractionation
schedule and radiation technique and/or the addition of
biological targets such as EGFR-inhibitors, that do not
interfere with radiation-induced side effects.
New radiation techniques (IMRT/IGRT and SBRT)
and re irradiation studies with molecular targeted therapies
could offer the possibility of greater disease control with
less toxicity. Identification of the molecular mechanisms
contributing to the pathogenesis and therapeutic resistance
of HNSCC in recurrence settings is crucial for developing
more effective re-irradiation protocols. New studies are
being conducted that could offer encouraging approaches in
the near future. Final suggestions to further improve in this
field are described in (Bentzen et al., ٢٠١٠). In addition,
advanced radiation techniques, such as tomotherapy or
proton-beam therapy, may facilitate treatment near the base
of skull.