Despite advances in the treatment of head and neck cancer, 15 to 50 percent of patients will develop recurrent disease [1-6]. Survivors also are at risk to develop second primary tumors, the incidence of which is estimated at 8 to 22 percent with about a third occurring in the head and neck. (See "Second primary malignancies in patients with head and neck cancers".)
Therapeutic options are limited for patients who present with locally recurrent disease or a second primary tumor in a previously irradiated field. Surgical salvage with a curative-intent resection is the preferred option for those with limited-volume disease [7-9]. Reirradiation is an alternative for patients who are not candidates for surgical salvage [9,10].
Reirradiation with or without the addition of chemotherapy may hold promise for long-term survival for appropriately selected patients. Indications for reirradiation may include:
- Patients who undergo surgical salvage but are found to have high-risk features.
- Patients who are medically suitable for curative-intent interventions but are not amenable to curative-intent resection.
- Patients who are not candidates for curative-intent interventions, but may benefit from palliative treatment.
General principles of treatment for locally recurrent and second primary head and neck cancer are discussed separately. Recurrence of nasopharynx cancer has a markedly better prognosis than other head and neck sites, and its management is also discussed separately.