Salama Joseph K, Vokes Everett E
Department of Radiation and Cellular Oncology, University of Chicago, Chicago, IL 60637, USA.
Semin Oncol. 2008 Jun;35(3):251-61. doi: 10.1053/j.seminoncol.2008.03.010.
Recurrent and second primary tumors arising within a previously radiated head and neck volume represent a difficult clinical scenario to manage. For patients who have resectable disease, surgery is the standard treatment. Chemotherapy is the standard for patients with unresectable or metastatic disease but offers no chance for cure. Re-irradiation (RRT) with concurrent chemotherapy is a potentially curative treatment option. In this article, we will review the basis for current chemoradiotherapy (CRT) regimens used in previously radiated patients, focusing on outcome and toxicity. Additionally, we will review radiotherapy techniques used in this setting and highlight the differences between definitive radiotherapy and RRT. Controversies, such as the utility of chemotherapy and RRT following surgical salvage, will be addressed. Finally, we will review investigations seeking to improve the therapeutic outcomes of patients treated with chemotherapy and RRT.
在先前接受过放射治疗的头颈部区域内出现的复发性肿瘤和第二原发性肿瘤，是一种难以处理的临床情况。对于患有可切除疾病的患者，手术是标准治疗方法。化疗是不可切除或转移性疾病患者的标准治疗方法，但无法治愈。同步化疗的再照射（RRT）是一种潜在的治愈性治疗选择。在本文中，我们将回顾目前用于先前接受过放射治疗患者的放化疗（CRT）方案的依据，重点关注疗效和毒性。此外，我们将回顾在此情况下使用的放射治疗技术，并强调根治性放疗和RRT之间的差异。还将讨论一些争议问题，如手术挽救后化疗和RRT的效用。最后，我们将回顾旨在改善接受化疗和RRT治疗患者治疗效果的研究。
