Reirradiation and re-reirradiation in head-and-neck cancers: Learnings based on a case irradiated six times.

Second primary cancers and locoregional recurrences in head and neck cancers are common. Management is challenging owing to the effects of previous treatment. Locoregional therapy, whenever feasible, offers possibility of cure. We have managed a patient who has over a period of 15 years been treated seven times. Treatment included surgical resection four times, flap reconstruction thrice, postoperative radiation thrice, radiation therapy alone thrice. Brachytherapy has been used in two instances, intraoperative brachytherapy once and surface mould application once. Patient has maintained a good quality of life during these fifteen years but suffers from xerostomia and nasogastric tube dependence at present. The management of this patient teaches us important lessons in terms of using modern surgery and advances in radiation therapy for achieving good patient benefit. [ABSTRACT FROM AUTHOR]