Retreatment of Recurrent or Second Primary Head and Neck Cancer After Prior Radiation: Executive Summary of the American Radium Society Appropriate Use Criteria

Int J Radiat Oncol Biol Phys. 2022 Jul 15;113(4):759-786. doi: 10.1016/j.ijrobp.2022.03.034. Epub 2022 Apr 8.


Retreatment of recurrent or second primary head and neck cancers occurring in a previously irradiated field is complex. Few guidelines exist to support practice. We performed an updated literature search of peer-reviewed journals in a systematic fashion. Search terms, key questions, and associated clinical case variants were formed by panel consensus. The literature search informed the committee during a blinded vote on the appropriateness of treatment options via the modified Delphi method. The final number of citations retained for review was 274. These informed 5 key questions, which focused on patient selection, adjuvant reirradiation, definitive reirradiation, stereotactic body radiation, and reirradiation to treat nonsquamous cancer. Results of the consensus voting are presented along with discussion of the most current evidence. This provides updated evidence-based recommendations and guidelines for the retreatment of recurrent or second primary cancer of the head and neck.

Publication types

  • Review

MeSH terms

  • Head and Neck Neoplasms* / radiotherapy
  • Humans
  • Neoplasm Recurrence, Local / drug therapy
  • Neoplasm Recurrence, Local / radiotherapy
  • Neoplasms, Second Primary* / drug therapy
  • Neoplasms, Second Primary* / radiotherapy
  • Radium* / therapeutic use
  • Re-Irradiation*
  • Retreatment
  • United States


  • Radium