Reirradiation of head and neck cancer focusing on hypofractionated stereotactic body radiation therapy
1 Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajiicho Kawaramachi Hirokoji, Kamigyo-ku, Kyoto 602-8566 Japan
2 CyberKnife Center, Soseikai General Hospital, 126 Kami-Misu, Shimotoba Fushimi-ku, Kyoto Japan
3 Radiotherapy Department, Fujimoto Hayasuzu Hospital, Hayasuzu 17-1, Miyakonojo, Miyazaki 885-0055, Japan
4 Department of Therapeutic Radiology, Japanese Red Cross Medical Center, Hiroo, Shibuya-ku, 4-1-22, Tokyo, Japan
5 Department of Radiology, Japanese Red cross Okayama Hospital, Aoe 2-1-1, Kita-ku, Okayama, Okayama Japan
Radiation Oncology 2011, 6:98 doi:10.1186/1748-717X-6-98Published: 21 August 2011
Reirradiation is a feasible option for patients who do not otherwise have treatment options available. Depending on the location and extent of the tumor, reirradiation may be accomplished with external beam radiotherapy, brachytherapy, radiosurgery, or intensity modulated radiation therapy (IMRT). Although there has been limited experience with hypofractionated stereotactic radiotherapy (hSRT), it may have the potential for curative or palliative treatment due to its advanced precision technology, particularly for limited small lesion. On the other hand, severe late adverse reactions are anticipated with reirradiation than with initial radiation therapy. The risk of severe late complications has been reported to be 20- 40% and is related to prior radiotherapy dose, primary site, retreatment radiotherapy dose, treatment volume, and technique. Early researchers have observed lethal bleeding in such patients up to a rate of 14%. Recently, similar rate of 10-15% was observed for fatal bleeding with use of modern hSRT like in case of carotid blowout syndrome. To determine the feasibility and efficacy of reirradiation using modern technology, we reviewed the pertinent literature. The potentially lethal side effects should be kept in mind when reirradiation by hSRT is considered for treatment, and efforts should be made to minimize the risk in any future investigations.