Results of postoperative reirradiation for recurrent or second primary head and neck carcinoma

In this prospective study, the effects of a second course of postoperative radiation therapy on locoregional control, survival, toxicity, and quality of life were investigated in patients who underwent resection of a second primary or locoregional recurrent head and neck tumor in a previously irradiated area.In total, 39 patients who underwent surgery for second primary tumors (n = 19 patients) or for recurrent locoregional tumors (n = 20 patients) were retreated with postoperative radiotherapy (RE‐PORT). Indications for RE‐PORT were extranodal spread (49%), positive surgical margins (44%), and/or other risk factors (8%). The target volume for RE‐PORT was confined to the high‐risk area. No elective radiotherapy was applied in regions that were situated in the formerly high‐dose area. A total dose of 46 grays (Gy) was given to elective areas with boosts from 60 Gy to 66 Gy to the high‐risk region with conventional fractionation. The results of RE‐PORT were compared with the results from patients who were treated in the same period with primary adjuvant radiotherapy (PRI‐PORT) at the authors' institution.The mean follow‐up was 32 months (range, 3‐84 mos). The locoregional control rate after 3 years in the RE‐PORT group was 74%, and the 3‐year overall survival rate was 44%. This did not differ significantly compared with survival rates in the PRI‐PORT group. Although a higher rate of late radiation‐induced morbidity and more head and neck symptoms were observed in the RE‐PORT group compared with the PRI‐PORT group, no differences were observed with regard to the more general dimensions of quality of life.RE‐PORT after surgery for recurrent locoregional tumors and/or second primary tumors should be considered in patients who have high‐risk histopathologic features. Cancer 2006. © 2006 American Cancer Society.