Second Course Of Radiotherapy Research Articles

Benign Paroxysmal Positional Vertigo in Irradiated Nasopharyngeal Carcinoma Survivors

Purpose. It has been assumed that postirradiated nasopharyngeal carcinoma (NPC) patients are prone to benign paroxysmal positional vertigo (BPPV). The purpose of this study was to better understand this clinical entity. Materials and Methods. From September 2003 to June 2011, we conducted a retrospective study of 11 irradiated NPC patients with BPPV in our institute. During the same period, 11 irradiated NPC patients without BPPV were randomly selected and enrolled as the control group. All medical records of these patients were evaluated. Results. The risk of BPPV rises significantly when the patient undergoes radiotherapy (RT) twice and the threshold radiation dose is >120 Gy (P = 0.027). The occurrence of postirradiated BPPV was significantly related to incidences of otitis media and sensorineural hearing loss (SNHL) (P = 0.011 and 0.009, resp.). All the patients responded well to repositioning maneuvers. Conclusion. A second course of RT, postirradiated otitis media, or SNHL is associated with the potential risk of radiation-induced BPPV. Repositioning maneuvers were safe and effective for relief of this disease.

Thoracic Re-irradiation May Be an Option for Recurrent, Metastatic, or Secondary Primary Non-Small Cell Lung Cancer

Thoracic Re-irradiation May Be an Option for Recurrent, Metastatic, or Secondary Primary Non-Small Cell Lung Cancer

Reirradiation of Canine Nasal Carcinomas Treated with Coarsely Fractionated Radiation Protocols: 37 Cases

Data from 37 dogs with nasal carcinomas treated with two or more coarsely fractionated courses of radiation therapy (RT) were retrospectively reviewed. The median radiation dose for the first course of RT was 24 Gray (Gy). All dogs clinically responded, and 11 had complete resolution of signs for a median of 114 days. Dogs were retreated at relapse, with a median dose of 20 Gy, and 26 of 37 dogs (70%) had clinical responses. The second course of RT was initiated at a median of 150 days following completion of the first course. Side effects were mild: four dogs had chronic ocular conditions necessitating medication, one of which required enucleation. Median survival time (ST) from the first dose of RT was 453 days and 180 days from the first dose of the second course of RT. The following factors were examined but were not significant for survival: total RT dose, dose of the first course of RT, complete resolution of clinical signs, use of either chemotherapy or nonsteroidal anti-inflammatory drugs (NSAIDs), and stage (T1/T2 versus T3/T4). Dogs responded well to reirradiation with a subset experiencing chronic ocular side effects.

Reirradiation in progressive high-grade gliomas: outcome, role of concurrent chemotherapy, prognostic factors and validation of a new prognostic score with an independent patient cohort

PurposesFirst, to evaluate outcome, the benefit of concurrent chemotherapy and prognostic factors in a cohort of sixty-four high-grade glioma patients who underwent a second course of radiation therapy at progression. Second, to validate a new prognostic score for overall survival after reirradiation of progressive gliomas with an independent patient cohort.Patients and methodsAll patients underwent fractionated reirradiation with a median physical dose of 36 Gy. Median planned target volume was 110.4 ml. Thirty-six patients received concurrent chemotherapy consisting in 24/36 cases (67%) of carboplatin and etoposide and in 12/36 cases (33%) of temozolomide. We used the Kaplan Meier method, log rank test and proportional hazards regression analysis for statistical assessment.ResultsMedian overall survival from the start of reirradiation was 7.7 ± 0.7 months. Overall survival rates at 6 and 12 months were 60 ± 6% and 24 ± 6%, respectively. Despite relatively large target volumes we did not observe any major acute toxicity. Concurrent chemotherapy did not appear to improve outcome. In contrast, female gender, young age, WHO grade III histology, favorable Karnofsky performance score and complete resection of the tumor prior to reirradiation were identified as positive prognostic factors for overall survival. We finally validated a recent suggestion for a prognostic score with our independent but small patient cohort. Our preliminary findings suggest that its ability to discriminate between different prognostic groups is limited.ConclusionsOutcome of our patients was comparable to previous studies. Even in case of large target volumes reirradiation seems to be feasible without observing major toxicity. The benefit of concurrent chemotherapy is still elusive. A reassessment of the prognostic score, tested in this study, using a larger patient cohort is needed.

Proton reirradiation of locally recurrent pancreatic and ampullary adenocarcinomas.

317 Background: Local recurrences of pancreatic and ampullary cancer can be painful and cause significant morbidity. Their treatment after resection and chemoradiation is particularly challenging. A second course of radiotherapy (RT) in a previously radiated field carries the risk of RT-induced tissue injury. Proton therapy (PRT) may offer an advantage in the reirradiation setting due to the lack of exit dose and potential sparing of normal tissues. Methods: Between 2/2011 and 8/2012, 10 adult patients (pts) with locally recurrent pancreatic or ampullary malignancies in or near prior treatment fields began reirradiation. Toxicity was graded according to the CTC v4.0. Acute toxicity was defined within 90 days from start of PRT. Results: Median follow-up was 8.2 months (1.1-19.1) from the start of retreatment and 15 months (2.4-27.8) from the development of local recurrence. Mean age was 67 (54-75). Nine of the pts had pancreatic adenocarcinoma and 1 had ampullary adenocarcinoma. Median clinical target volume size was 86.4 cc (15-236). Nine received concurrent 5-fluorouracil or capecitabine-based chemotherapy. The median total dose was 59.4 Gy(RBE)(45-59.4); all pts were treated with PRT exclusively, except for one pt who was treated with 36% photon volumetric arc therapy. The median prior dose was 50.4 Gy (30-59.4). The median interval between RT courses was 34 months (17-461). Nine pts had Grade 2 and 1 had only Grade 1 non-hematologic acute toxicity. No Grade 2 or higher non-hematologic RT-related toxicities were observed after 90 days from the start of RT. Five pts developed metastatic disease at a median of 7.4 months (4.8-13.2) after starting RT, 1 of whom died at 5.3 months. One pt developed progressive regional (paraaortic) disease inferior to the fields while on treatment and was stopped early at 45 Gy. One pt developed a regional metastasis (porta hepatis) outside of the retreated volume. The other 8 pts were controlled locally within the retreated fields. Conclusions: Reirradiation of pancreatic/ampullary cancers with PRT and concurrent chemotherapy has minimal acute toxicity and encouraging short-term local control. Further follow-up on these pts is needed to assess the long-term morbidity and utility of PRT reirradiation. Clinical trial information: NCT01126476.

Reirradiation of recurrent meningioma

Management of meningioma includes observation, resection, and radiation therapy (RT). For patients with recurrent disease, similar options exist. However, the control rate following a second course of RT for recurrent disease is unknown. We reviewed an institutional database of patients with meningioma treated with stereotactic radiosurgery or fractionated stereotactic RT who underwent a second course for recurrent disease. Cox regression model was used for analysis. Variables tested included tumor volume, RT type, tumor grade, age at diagnosis, time to progression, and interval between RT. Eleven of 19 patients (58%) experienced disease progression. Median time to second progression was 10months. Freedom from progression at one year was lower in patients with grade II or III tumors compared to those with grade 1 or unknown histology (17% compared to 92%, p=0.0054). Cox regression showed that a grade II–III tumor affects progression-free survival (PFS), with a hazard ratio of 5.37 (p=0.011). Median time to progression (MTP) for patients with grade II–III tumors was eight months. MTP was not reached for patients with grade 1/unknown tumors. Reirradiation for recurrent meningioma yields modest tumor control rates but for patients with grade II or III tumors, outcomes are poor.

Radiation treatment parameters for re-irradiation of malignant glioma

Most patients with malignant glioma ultimately fail locally or loco-regionally after the first treatment, with re-irradiation being a reasonable treatment option. However, only limited data are presently available allowing for a precise selection of patients suitable for re-treatment with regard to safety and efficacy. Using the department database, 39patients with a second course of radiation were identified. Doses to gross tumor volume (GTV), planning target volume (PTV), and relevant organs at risk (OARs; brainstem, optic chiasm, optic nerves, brain) were retrospectively analyzed and correlated to outcome parameters. Relevant treatment parameters including D(max), D(min), D(mean), and volume (ml) were obtained. Equivalent uniform dose (EUD) values were calculated for the tumor and OARs. To address the issue of radiation necrosis/leukoencephalopathy posttherapeutic MRI images were routinely examined every 3months. Median follow-up was 147days. The time interval between first and second irradiation was regularly greater than 6months. Median EUDs to the OARs were 11.9Gy (range 0.7-27.4Gy) to the optic chiasm, 17.6Gy (range 0.7-43.0Gy) to the brainstem, 4.9/2.1Gy (range 0.3-24.5Gy) to the right/left optic nerve, and 29.4Gy (range 25.2-32.5Gy) to the brain. No correlation between treated volume and survival was observed. Cold spots and dose did not correlate with survival. Re-irradiated volumes were treated with on average lower doses if they were larger and vice versa. In general, re-irradiation is a safe and feasible re-treatment option. No relevant toxicity was observed after re-irradiation in our patient cohort during follow-up. In this regard, this analysis provides baseline data for the selection of putative patients. EUD values are derived and may serve as reference for further studies, including intensity-modulated radiotherapy (IMRT) protocols.

Clinical Results of Radiotherapy for Primary Intraocular Non-Hodgkin's Lymphoma

Clinical Results of Radiotherapy for Primary Intraocular Non-Hodgkin's Lymphoma

Generation and Validation of a Prognostic Score to Predict Outcome after Re-irradiation of Recurrent Glioma

Re-irradiation has been established within the clinical routine for patients with recurrent gliomas. To date, no analysis has shown which patients benefit most from a second course of radiotherapy, and which prognostic factors should be taken into consideration for decision making. In the present work, we developed a prognostic score to predict outcome after re-irradiation and validated the scale in a group of patients with recurrent gliomas.

Second Course of Radiation for New Primary Head-and-Neck Cancer

To analyze patient and tumor characteristics, and survival of patients who received 2 courses of radiotherapy for different primary head and neck cancers (HNCs). A total of 234 patients who underwent 2 courses of radiotherapy for different primary, localized, or regional HNCs registered in the population-based Surveillance, Epidemiology, and End Results database were identified. The latency between first and second irradiated HNCs ranged from 0.3 to 28.8 years (median, 6.3 years). Only 22% of first irradiated HNCs were node positive, and only 22% of second irradiated HNCs were node positive. After the diagnosis of the second irradiated HNC, the 1-, 2-, and 5-year overall survivals were 68%, 40%, and 17%, respectively. The variables of gender, race, latency, and stage of second cancer did not significantly impact survival. At the time of diagnosis of second irradiated HNC, younger age (P = 0.026), later year of diagnosis (P = 0.005), and cancer-directed surgery (P = 0.032) were favorable predictors of improved survival. With Cox regression analyses, younger age (P = 0.060) and cancer-directed surgery for the second irradiated HNC (HR = 0.75, 95% CI: 0.55-1.01, P = 0.062) were borderline significantly favorable risk factors, whereas year of diagnosis (P = 0.13) was not. From a population-based analysis, patients undergoing a second course of radiation for HNC appear to benefit from cancer-directed surgery, although this did not reach statistical significance with Cox regression analyses. The improved outcome after resection is perhaps attributable to a therapeutic benefit from surgery and/or more indolent disease among those amenable to resection.

Re-irradiation with scanned charged particle beams in recurrent tumours of the head and neck: Acute toxicity and feasibility

BackgroundTreatment of surgically unresectable recurrence in the head and neck region remains a therapeutic problem with the only curative option being a second course of radiation with a tumouricidal dose. We report initial toxicity and efficacy of charged particle therapy in this situation. MethodsTreatment-related side-effects of patients treated with charged particle beams for recurrent tumours of the head and neck were prospectively collected and patient data was retrospectively analysed with regard to toxicity and efficacy of the treatment according to CTCAE v. 4.03 and RECIST. ResultsTreatment was tolerated well without any severe acute toxicity. In non-chordoma/chondrosarcoma patients, overall response rate was 53.3% at 8weeks post RT. 4/5 chordoma/chondrosarcoma patients showed no signs of further tumour progression. ConclusionInitial experience of re-irradiation with scanned particle beams in recurrent tumours of the head and neck seems feasible and encouraging. Further follow-up is needed to investigate potential late effects.

Reirradiation as a Component of the Multidisciplinary Management of Locally Recurrent Breast Cancer

Background and Purpose Our intent was to review a modern multidisciplinary institutional experience involving reirradiation of the breast, chest wall, and lymphatics for locoregional recurrences of breast cancer and report toxicity and clinical outcomes. Materials and Methods Between 1995 and 2009, 12 locoregional recurrences were reirradiated in 8 patients. The mean dose of initial radiotherapy was 57.1 Gy (range, 50.4-60.6 Gy), and the mean dose of reirradiation was 46.7 Gy (range, 30-62.1 Gy). The second course of radiotherapy was delivered using daily radiotherapy to 5 recurrences, twice-daily radiotherapy to 5 recurrences (1 with mold brachytherapy boost), and a combination of once- and twice-daily radiotherapy to 2 recurrences. Results The median follow-up from time of completion of reirradiation was 30 months (range, 1.5-67 months). Local control was achieved in 7 of 8 patients and 11 of 12 recurrences. Regional control was achieved in 5 of 8 patients and 6 of 12 recurrences. Distant control was achieved in 5 of 8 patients. At time of analysis, 5 of 8 patients were alive. Median survival since reirradiation completion was 36 months (range, 4.5-47 months). Acute toxicity included grade 2 dermatitis in 4 patients, ipsilateral shoulder pain in 1 patient, and ipsilateral pleurisy in 1 patient. Late skin and soft tissue toxicity manifested as fibrosis in 4 patients, hyperpigmentation in 3 patients, and telangiectasia in 3 patients. Three patients reported lymphedema, 1 patient reporting chest wall pain and 1 patient with an ipsilateral rib fracture. Conclusions Multidisciplinary management of locoregional recurrence of breast cancer using reirradiation is well tolerated as salvage treatment and provides durable locoregional control.

Randomised phase I/II study to evaluate carbon ion radiotherapy versus fractionated stereotactic radiotherapy in patients with recurrent or progressive gliomas: The CINDERELLA trial

BackgroundTreatment of patients with recurrent glioma includes neurosurgical resection, chemotherapy, or radiation therapy. In most cases, a full course of radiotherapy has been applied after primary diagnosis, therefore application of re-irradiation has to be applied cauteously. With modern precision photon techniques such as fractionated stereotactic radiotherapy (FSRT), a second course of radiotherapy is safe and effective and leads to survival times of 22, 16 and 8 months for recurrent WHO grade II, III and IV gliomas.Carbon ions offer physical and biological characteristics. Due to their inverted dose profile and the high local dose deposition within the Bragg peak precise dose application and sparing of normal tissue is possible. Moreover, in comparison to photons, carbon ions offer an increased relative biological effectiveness (RBE), which can be calculated between 2 and 5 depending on the GBM cell line as well as the endpoint analyzed. Protons, however, offer an RBE which is comparable to photons.First Japanese Data on the evaluation of carbon ion radiation therapy for the treatment of primary high-grade gliomas showed promising results in a small and heterogeneous patient collective.Methods DesignIn the current Phase I/II-CINDERELLA-trial re-irradiation using carbon ions will be compared to FSRT applied to the area of contrast enhancement representing high-grade tumor areas in patients with recurrent gliomas. Within the Phase I Part of the trial, the Recommended Dose (RD) of carbon ion radiotherapy will be determined in a dose escalation scheme. In the subsequent randomized Phase II part, the RD will be evaluated in the experimental arm, compared to the standard arm, FSRT with a total dose of 36 Gy in single doses of 2 Gy.Primary endpoint of the Phase I part is toxicity. Primary endpoint of the randomized part II is survival after re-irradiation at 12 months, secondary endpoint is progression-free survival.DiscussionThe Cinderella trial is the first study to evaluate carbon ion radiotherapy for recurrent gliomas, and to compare this treatment to photon FSRT in a randomized setting using an ion beam delivered by intensity modulated rasterscanning.Trial RegistrationNCT01166308

Reirradiation for Recurrent Meningioma

Management options for meningioma include observation, surgical resection, and radiation therapy (RT). In cases of progressive or recurrent disease after RT, similar options exist. The control rate following a second course of RT is unknown.

Reirradiation for Recurrent Meningioma

Purpose/Objective(s): Management options for meningioma include observation, surgical resection, and radiation therapy (RT). In cases of progressive or recurrent disease after RT, similar options exist. The control rate following a second course of RT is unknown.

Local Control of Metastatic Spinal Cord Compression Following Radiotherapy

Radiotherapy (RT) alone is the most frequently applied treatment modality for metastatic spinal cord compression (MSCC). Short-course RT (overall treatment time one week or less) provides a similar functional outcome to longer programmes. Therefore, short-course RT should be seriously considered for many MSCC patients, especially for those with a poor survival prognosis. By contrast, a considerable proportion of MSCC patients live long enough to experience a local recurrence of MSCC in the previously irradiated area of the spinal cord. Long-course RT (30–40Gy in two to four weeks) results in significantly better local control than short-course RT and should therefore be administered to patients with a more favourable survival prognosis. Survival can be estimated with a newly developed scoring system. If re-irradiation is required, a second course of RT can be safely administered in most cases after primary short-course RT. After primary long-course RT, re-irradiation should optimally be performed with high-precision techniques in order to reduce the risk of radiation-related myelopathy.

Combined Cetuximab and Reirradiation for Locoregional Recurrent and Inoperable Squamous Cell Carcinoma of the Head and Neck

To investigate the feasibility, toxicity, and efficacy of external-beam reirradiation (Re-RT) combined with cetuximab for patients with inoperable and recurrent squamous cell carcinoma of the head and neck (SCCHN). Seven patients with inoperable recurrence of SCCHN after adjuvant or definitive radiotherapy (RT) and simultaneous or sequential cisplatin-based chemotherapy for primary SCCHN were treated between August and December 2008 with Re-RT (1.8 Gy/fraction to 50.4 Gy) and cetuximab (400 mg/m(2) initial dose in the 1st week, and then 250 mg/m(2) once weekly). Recurrence had to be located at least > or = 50% in the preirradiated field. Long term toxicity from previous treatment was recorded before Re-RT as a baseline value. Acute and late toxicity derived from the experimental regimen were recorded every week during RT, and then every 3 months. Efficacy was assessed with repeated imaging using response evaluation criteria in solid tumors (RECIST) and clinical examinations 8-12 weeks after end of the treatment and every 3 months thereafter (Tables 1 and 2). Only mild localized mucositis occurred in all patients. Two patients developed a grade 3 acneiform rash related to cetuximab. After treatment one patient developed a grade 2 trismus, another showed grade 3 abacterial salivary gland inflammation with severe pain requiring opioid medication. Two patients achieved a complete response after 7 months, one remained stable, three progressed, and one died from pneumonia without having restaging magnetic resonance imaging. A second course of RT combined with cetuximab in patients with inoperable, recurrent HNSCC proved to be feasible with mild or moderate toxicity and encouraging response to treatment.

Every Cancer Patient Needs Radiation Therapy!

DOI: 10.1200/JCO.2008.21.6762 The request for consultation is submitted. A 72-year-old retired engineer with renal cell carcinoma has back pain due to bone metastases in the thoracic vertebral bodies (T6-T10). The pain is refractory to opioid analgesics. The referring physician underscores that the patient received a course of spinal irradiation to this region 3 years ago and derived significant benefit. Our service is consulted to determine whether reirradiation to the same area is possible. The question has intriguing radiobiological consequences, and I send the resident physician to see the patient; she returns 3 hours later. She is beaming with pride. She has acquired a sense of scholarship about the patient and the disease. As she walks into my office, there is a newfound swagger about her, and she is clearly anxious to disclose her findings to me. After providing a summary of the disease history, including a learned dissertation about the targeted therapies, which he did not respond to during the interval since diagnosis, she concludes with a piece of information that the other physicians have overlooked. It turns out that the patient has already been reirradiated to the thoracic spine as part of an experimental protocol at a neighboring hospital. Although the chart did not initially contain a summary of that second course of radiotherapy, she has since obtained the treatment records and portal images from the hospital down the road. Retreating is not an option since he has received the maximum allowable dose. As much as I consider myself a “treater,” even I have my limits. I conclude that absent an institutional review board–approved protocol for re-reirradiation, I must decline to subject this older gentleman to the beam. In view of the dose-fractionation schedules employed and the volumes of tissue exposed, we resolve that we cannot introduce any more radiotherapy, even with an armamentarium at our disposal that includes the latest in therapies (eg, intensity-modulated radiation therapy, stereotactic body radiation therapy, and so on). The time has come for me to meet the patient. Together, the resident and I cross the bridge that leads to the ward where the patient waits. This wing of the medical center has not yet been renovated, and it feels that we have stepped back into the hospital that time has forgotten. Just before we enter the room, the resident unleashes a volley of existential questions directed at me, her senior (supposedly more knowledgeable) mentor. “How can we help him maintain hope? How can despair be averted? Have we nothing to offer?!” I am introduced as the attending physician. I, too, am anxious when I realize that there is no obvious oncologic intervention for me to recommend. Just as I am about to come up with some meaningless jargon, the resident again draws down on her instincts as healer. She sits on the edge of the bed and engages the patient in conversation. By now, she has learned enough about his social history to carry out sophisticated small talk. Neither he nor she appears to notice me. In some way she has deftly managed to convey that we can not treat him. He is unphased and much more interested in keeping the dialogue alive. The patient then endeavors to bring me into the conversation. In addition to a very high intelligence quotient, he is endowed with large quantities of emotional intelligence. “Do you see what she has done?” he queries me as if I am the junior trainee in need of didactic teaching. I am not given the opportunity to respond. Instead, he continues. “This budding cancer specialist, this exquisite young lady is gifted. She has managed to convey to me that there is nothing that can be actively pursued. But she has made it clear, and I believe her, that she will not abandon me. She has smothered me with her presence. She radiates love.” It is the latter statement that lingers within me. Suddenly, I realize that we can avail ourselves of another type of radiation therapy— one that has nothing to do with linear accelerators or heavy particles, but everything to do with being sincere. It is a radiation therapy that is not an outgrowth of an Ivy League education, but one that is borne of intense empathy. It is a form of JOURNAL OF CLINICAL ONCOLOGY T H E A R T O F O N C O L O G Y: When the Tumor Is Not the Target VOLUME 27 NUMBER 13 MAY 1 2009

Hypofractionated reirradiation for recurrent malignant glioma

Treatment options for recurrent high-grade glioma after a complete course of radiotherapy comprise surgery, reirradiation and chemotherapy but the efficacy of any of the given salvage treatments is limited. In order to further define the role of short-term radiotherapy as retreatment option for selected patients, we analyzed outcomes after treatment with a hypofractionated radiation. Treatment outcomes (overall survival and treatment-associated toxicity) were analyzed retrospectively in 31 patients treated between 1994 and 2007. Hypofractionated radiotherapy was performed after three-dimensional CT planning with a median total dose of 20 Gy in a single department. With a median interval of 20 months from primary radiotherapy, two grade III and 29 grade IV tumors were reirradiated. Pretreatment consisted of surgery and involved-field radiotherapy (median 59 Gy). 77% of the patients received additional chemotherapy before the second course of radiotherapy, and 48% were treated after secondary resection. The median overall survival after hypofractionated radiotherapy was 10.2 months, and the median overall survival time after primary diagnosis 30.9 months. No severe toxicity was observed. Hypofractionated reirradiation with 20 Gy given over 1 week is a practicable and well-tolerated treatment option for patients with recurrent malignant glioma. The overall survival was comparable to the reported outcomes from other series including those with longer treatment protocols.

Reirradiation After Surgery and Microvascular Reconstruction

Problem To evaluate the outcome and complications of reirradiation of recurrent head and neck cancer after salvage surgery and microvascular reconstruction. Methods Retrospective Study. Twelve patients underwent salvage surgery with microvascular reconstruction for recurrent or new primary head and neck cancer in a previously irradiated field. Median prior RT dose was 63.0 Gy (range 30.0–72.8). Patients then underwent postoperative reirradiation, receiving a median total cumulative radiation dose of 115.0 Gy. Results Three patients (25%) experienced acute complications (<3 months) during reirradiation that resolved with conservative care. Four patients (33%) developed grade 3 or 4 late reirradiation complications (>3 months). There were no incidences of free flap failure. No patients suffered brain necrosis, spinal cord injury, or carotid rupture. The incidence of soft tissue necrosis and osteoradionecrosis was 8%. There were no treatment-related mortalities. Six patients (50%) are alive without evidence of recurrent disease a median of 40 months after reirradiation (range 4–64 months). Conclusion Free flap reconstruction followed by reirradiation is not associated with an increased risk of perioperative, acute, or late complications. Microvascular free flaps allow for maximal resection and reliable reconstruction of previously irradiated cancers before high dose reirradiation, and may reduce the incidence of severe late complications and treatment related mortality. Significance Reirradiation for recurrent head and neck squamous cell carcinoma remains controversial. However, increasing evidence has demonstrated improved survival and locoregional control with reirradiation at the cost of potentially severe or sometimes fatal radiation toxicity. We hypothesize that using well-vascularized tissue and bone at the time of salvage surgery can reduce the incidence of reirradiation complications. This would allow patients at high risk for recurrence to more safely receive a second course of radiation therapy. To our knowledge this is the first report of the effects of microvascular reconstruction on complications and outcomes of patients undergoing salvage surgery and external beam reirradiation.