Reirradiation of locally recurrent XXXX .

@entity1 @entity137 @entity39 @entity5 @entity189
PURPOSE: To study the efficacy of reirradiation as salvage treatment in @entity1 with locally recurrent @entity189 . @entity1 AND METHODS: Between 1993 and 2000, 20 consecutive @entity1 (twelve males and eight females) with @entity5 , previously irradiated in different Hungarian institutions, were reirradiated for biopsy-proven locally recurrent @entity5 . Histologically, 85% of the @entity1 had WHO type III, 5% type II, and 10% type I disease. Stages I-IV (AJCC 1997 staging system) were assigned to five (25%), seven (35%), five (25%), and three (15%) @entity1 , respectively; none of them had distant metastases, and only eight (40%) displayed regional dissemination. The median time period between termination of primary treatment and local recurrence was 30 (range, 10-204) months. Brachytherapy was the method most frequently used: in ten cases alone (especially for rT1 @entity5 ), and in eight cases in combination with external beam therapy. Two @entity1 with locally advanced disease underwent external beam therapy only. The median dose in the event of brachytherapy alone was 20 Gy (4 x 5 Gy or 5 x 4 Gy, range, 16-36 Gy), and the dose range for exclusive external irradiation was 30-40 Gy. In cases of combined irradiation, a median 20-Gy brachytherapy (range, 16-40 Gy) was associated with 30-40 Gy of external irradiation. Radiotherapy was supplemented by neck dissection (six @entity1 ), nasopharyngectomy (one @entity1 ), or chemotherapy (eleven @entity1 ). RESULTS: 16 @entity1 were reirradiated once, three twice, and one @entity1 three times, with a median equivalent dose for @entity5 effect of 36 Gy (mean, 44 Gy; range, 19-117 Gy; the estimated alpha/beta-ratio was 10 Gy). The median equivalent dose of reirradiation for late effect on normal tissue (with an estimated 70% delivery of the @entity5 dose) amounted to 30 Gy (mean, 37 Gy; range, 13-101 Gy, estimated alpha/beta-ratio 3 Gy). After a median follow-up of 37 (range, 12-72) months, the overall survival was 60% (12/20). Seven of the twelve surviving @entity1 are currently @entity5 -free. After primary irradiation, xerostomy occurred in all @entity1 as an unavoidable side effect of treatment. Following reirradiation, a severe (grade 3 or higher) late @entity137 (CTC criteria, version 2) has been observed in two @entity5 -free @entity1 (10%) so far ( @entity39 of soft palate and paresis of glossopharyngeal nerve). CONCLUSION: Retreatment of @entity189 with radiotherapy (preferably a combined modality), can result in longterm local control and survival in a substantial proportion of @entity1 , at the price of an acceptable morbidity.
