Brachytherapy for recurrent head and neck cancer

The outlook for patients with recurrent HNC that is not amenable to treatment with curative surgery alone is grim. Reirradiation is often possible and can have a substantial effect on local tumor control. A dose of at least 60 Gy is needed, however, and should preferably be given using BT. Radiobiological considerations dictate the use of small fraction sizes. The role of hyperbaric oxygen in reducing the morbidity associated with reirradiation (by improving the vascularization status of irradiated normal tissue) deserves further investigation. Adequate imaging and recent developments in conformal radiotherapy (3D planning and intensity-modulated radiotherapy) and stereotactic radiotherapy should be utilized in order to apply high tumoricidal doses, while minimizing the incorporated volume of irradiated critical normal tissue.