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ACR Appropriateness Criteria® Retreatment of Recurrent Head and Neck Cancer After Prior Definitive Radiation

2011; Elsevier BV; Volume: 80; Issue: 5 Linguagem: Inglês

10.1016/j.ijrobp.2011.02.014

1879-355X

Mark W. McDonald, Joshua D. Lawson, Madhur Garg, Harry Quon, John A. Ridge, Nabil F. Saba, Joseph K. Salama, Richard V. Smith, Anamaria R. Yeung, Sue S. Yom, Jonathan J. Beitler,

Colorectal and Anal Carcinomas

Recurrent and second primary head-and-neck squamous cell carcinomas arising within or in close proximity to previously irradiated fields are a common clinical challenge. Whereas surgical salvage therapy is recommended for resectable disease, randomized data support the role of postoperative reirradiation in high-risk patients. Definitive reirradiation is an established approach for patients with recurrent disease who are medically or technically inoperable or decline radical surgery. The American College of Radiology Expert Panel on Head and Neck Cancer reviewed the relevant literature addressing re-treatment after prior definitive radiation and developed appropriateness criteria for representative clinical scenarios. Examples of unresectable recurrent disease and microscopic residual disease after salvage surgery were addressed. The panel evaluated the appropriateness of reirradiation, the integration of concurrent chemotherapy, radiation technique, treatment volume, dose, and fractionation. The panel emphasized the importance of patient selection and recommended evaluation and treatment at tertiary-care centers with a head-and-neck oncology team equipped with the resources and experience to manage the complexities and toxicities of re-treatment. Recurrent and second primary head-and-neck squamous cell carcinomas arising within or in close proximity to previously irradiated fields are a common clinical challenge. Whereas surgical salvage therapy is recommended for resectable disease, randomized data support the role of postoperative reirradiation in high-risk patients. Definitive reirradiation is an established approach for patients with recurrent disease who are medically or technically inoperable or decline radical surgery. The American College of Radiology Expert Panel on Head and Neck Cancer reviewed the relevant literature addressing re-treatment after prior definitive radiation and developed appropriateness criteria for representative clinical scenarios. Examples of unresectable recurrent disease and microscopic residual disease after salvage surgery were addressed. The panel evaluated the appropriateness of reirradiation, the integration of concurrent chemotherapy, radiation technique, treatment volume, dose, and fractionation. The panel emphasized the importance of patient selection and recommended evaluation and treatment at tertiary-care centers with a head-and-neck oncology team equipped with the resources and experience to manage the complexities and toxicities of re-treatment. Benefit of Optimizing the Dose to the Carotid in Hypofractionated Stereotactic Body Reirradiation?International Journal of Radiation Oncology, Biology, PhysicsVol. 81Issue 5PreviewTo the Editor: We read with interest the two reirradiation papers by McDonald et al., including that on the rate of carotid blowout (1, 2). Head-and-neck cancer patients who receive radiation doses of 60 to 70 Gy have a 21-fold increased risk of intima-media thickening (3), which is worsened by neck dissection (4), as well as multifocal pseudoaneurisms, and disruption of the vasa vasorum after vessel "skeletonization." Vascular radionecrosis appears as air bubbles, air–fluid level/marked hypodensity surrounding vessels on narrow-window CT scan. Full-Text PDF In Regard to "ACR Appropriateness Criteria of Recurrent Head-and-Neck Cancer After Prior Definitive Radiation." (Int J Radiat Oncol Biol Phys 2011;80:1292–1298)International Journal of Radiation Oncology, Biology, PhysicsVol. 82Issue 4PreviewTo the Editor: The expert head-and-neck panel recently published the American College of Radiology appropriateness criteria for treatment of recurrent head-and-neck cancer (rHNC) (1). Whereas this was overall a very valuable review and provides insight into this complex and controversial subject, we believe that there should have been mention of the role of stereotactic radiosurgery (SRS) and stereotactic body radiotherapy (SBRT) in the treatment of previously irradiated unresectable rHNC. SBRT was mentioned as a possible boost option for nasopharynx, but it has much wider applications. Full-Text PDF