Reirradiation: exploring new territory in the therapy of recurrent head and neck cancer

Traditionally, systemic chemotherapy has been the main form of treatment for recurrent squamous carcinoma of the head and neck. Unfortunately, response rates are seldom higher than 20-30%, with median survival times of 6-8 months. This paper explores the emerging role of reirradiation in the setting of recurrent squamous cell carcinoma of the head and neck; it reviews the existing literature focusing on radiation alone in this setting, and more recent literature integrating systemic radiosensitizing cytotoxics with reirradiation. Data from recent series using fluorinated pyrimidines and hydroxyurea, as well as platinating agents and taxanes, suggest occasional longterm survival benefits that exceed the historic norm. These approaches, largely confined to single institutions or small consortiums to date, are being evaluated prospectively in the cooperative group setting.