الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Recurrent head and neck cancer is challenging and constitutes the most common cause of death among survivors of head and neck cancer. Although surgery is the best tool for local control it is only feasible in minority of patients.
Re-irradiation is the best alternative tool to surgery for better locoregional control but with accepted associated toxicity.
This study included 30 patients with recurrent head and neck cancer treated with IMRT or VMAT and evaluated the response as regard locoregional control rate, durability of response and favorable prognostic factors associated with better outcomes. Moreover re-irradiation related toxicity especially rates of adverse events were assessed.
It was found that good locoregional control rates (complete response and partial response rates) were expressed in 77% denoting feasibility of re-irradiation in recurrent HNC.
Follow up 6 months had been assessed for patients in this study and it was found that nearly 50% still had no progression denoting good durability of response.
As regard favorable prognostic factors that could be used as better selection criteria for further studies, it was found that disease free interval between primary and recurrent tumor more than 15 months was the only statistically significant prognostic factor that associated with favorable outcomes.
Other favorable prognostic factors like reirradiation doses more than 60Gy, laryngeal or nasopharyngeal sites of recurrence use concomittent chemotherapy, postoperative reirradiation and good performance status.
Regarding re-irradiation toxicity it was found that only 23% of patients suffered from severe adverse events while majority did not denoting well tolerability of patients subjected to re-irradiation with IMRT or VMAT.
Mucositis and xerostomia is the most common related toxicity but its rate is low as compared to that with conventional reirradiation using 2D or 3D radiation therapy.
Arterial rupture and mucosal impaction still one of the causes of fatal events during or after reirradiation of recurrent head and neck cancer
In conclusion, reirradiation of recurrent head and neck cancer with IMRT or VMAT is feasible and the best alternative tool to surgery for locoregional control with accepted toxicity rates. Also better selection criteria are advisable especially disease time interval more than 15 months, small tumour volume and modern techniques of radiation therapy.
Recommendation:
1) Re-irradiation of recurrent head and neck cancer is advised if no chance of surgical resection.
2) Advanced techniques of radiation therapy like IMRT or VMAT help in decreasing toxicity rates and offer more feasibility of re-irradiation.
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3) selection criteria is recommended for patients planned for re-irradiation with IMRT or VMAT to get better response rates like free disease interval more than 15 months, smaller tumor volume and good performance status.
4) Although progress of reirradiation by IMRT or VMAT, Toxicity rates and fatal events still present and future studies is needed to evaluate the role of image guided radiotherapy, streotactc radiosurgery and particle therapy in the field of reirradiation of recurrent head and neck cancer.
5) More randomized comparative prospective trials is needed between different management lines or techniques to assess the best tools of management.