Camil Ciprian Mireștean, Roxana Irina Iancu, Dragoș Petru Teodor Iancu
Abstract
Although previously considered unnecessary and associated with a high toxicity rate, re-irradiation of head and neck cancers is currently an increasingly frequently used therapeutic option, both for curative and palliative purposes. However, there have been reports in the literature indicating 10-20% survival at 5 years for patients re-irradiated with the full dose. Without a consensus, the evidence argues for a re-irradiation dose of over 58Gy as being correlated with superior survival. Survival rates at 2 years were significantly higher (35%) compared to only 8% in favor of patients re-irradiated with a dose >58Gy. Carotid blow-out and osteoradionecrosis (ORN) of the mandible are currently more serious toxicities than potentially fatal myelitis, whose reporting rate was reduced, perhaps also because the subject benefits from extensive studies and clear dosimetric recommendations. Recent data suggest a possibility to limit the risk of carotid blowout and ORN by limiting cumulative doses to the carotid and mandible to <120Gy. Immunotherapy seems a feasible option for combination with re-irradiation. We have not yet identified data on combinations with new oncology therapies including vaccines, bispecific antibodies and antibody drug conjugates (ADC).
DOI : 10.62610/RJOR.2025.1.17.73
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