Organs at risk's tolerance and dose limits for head and neck cancer re-irradiation: A literature review

F. Dionisi, F. Fiorica, E. D'Angelo, M. Maddalo, I. Giacomelli, E. Tornari, A. Rosca, F. Vigo, D. Romanello, M. Cianchetti, F. Tommasino, M. Massaccesi, E. Orlandi

Research output: Contribution to journalReview articlepeer-review


Re-irradiation is becoming an established treatment option for recurrent or second primary head and neck cancer(HNC). However, acute and long-term RT-related toxicities could dramatically impact patients' quality of life. Due to the sparse literature regarding HNC re-irradiation, data on tolerance doses for various organs at risk (OARs) are scarce. Our aim was to systematically review the clinical literature regarding HNC re-irradiation, focusing on treatment toxicity, OARs tolerance, and dose limit recommendations. Thirty-nine studies (three randomized, five prospective, 31 retrospective) including 3766 patients were selected. The median interval time between the first course and re-irradiation was 28 months (range, 6–90). In 1043 (27.6%) patients, postoperative re-irradiation was performed. Re-irradiation doses ranged from 30 Gy in 3 fractions using stereotactic technique to 72 Gy in conventional fractionation using intensity-modulated radiotherapy. Pooled acute and late toxicityrates ≥G3 were 32% and 29.3%, respectively. The most common grade 3–4 toxic effects were radionecrosis, dysphagia requiring feeding tube placement and trismus. In 156 (4.1%) patients, carotid blowout was reported. Recommendations for limiting toxicity included the time interval between radiation treatments, the fractionation schedules, and the re-irradiation treatment volumes. Cumulative dose limit suggestions were found and discussed for the carotid arteries, temporal lobes, and mandible.

Original languageEnglish
Pages (from-to)35-47
Number of pages13
JournalOral Oncology
Publication statusPublished - Nov 2019


  • Carotid blowout
  • Head and neck cancer
  • Re-irradiation dose limits
  • Temporal lobe radionecrosis
  • Tolerance of organs at risk

ASJC Scopus subject areas

  • Oral Surgery
  • Oncology
  • Cancer Research


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