Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Head Neck. 2018 Sep;40(9):2078-2093. doi: 10.1002/hed.25180. Epub 2018 Apr 23.
Locoregional disease recurrence or development of a second primary cancer after definitive radiotherapy for head and neck cancers remains a treatment challenge. Reirradiation utilizing traditional techniques has been limited by concern for serious toxicity. With the advent of newer, more precise radiotherapy techniques, such as intensity-modulated radiotherapy (IMRT), proton radiotherapy, and stereotactic body radiotherapy (SBRT), there has been renewed interest in curative-intent head and neck reirradiation. However, as most studies were retrospective, single-institutional experiences, the optimal modality is not clear. We provide a comprehensive review of the outcomes of relevant studies using these 3 head and neck reirradiation techniques, followed by an analysis and comparison of the toxicity, tumor control, concurrent systemic therapy, and prognostic factors. Overall, there is evidence that IMRT, proton therapy, and SBRT reirradiation are feasible treatment options that offer a chance for durable local control and survival. Prospective studies, particularly randomized trials, are needed.
头颈部癌症根治性放疗后局部区域疾病复发或第二原发癌的发生仍然是治疗的挑战。由于担心严重毒性，传统技术的再放疗受到限制。随着新型、更精确的放疗技术的出现，如调强放疗（IMRT）、质子放疗和立体定向体部放疗（SBRT），人们对根治性头颈部再放疗重新产生了兴趣。然而，由于大多数研究都是回顾性的、单机构经验，因此最佳方式尚不清楚。我们对头颈部再放疗的这 3 种技术的相关研究结果进行了全面回顾，然后对毒性、肿瘤控制、同期全身治疗和预后因素进行了分析和比较。总的来说，有证据表明，IMRT、质子治疗和 SBRT 再放疗是可行的治疗选择，为持久的局部控制和生存提供了机会。需要开展前瞻性研究，特别是随机试验。
