Here we go again.

No one wants to open up the next consult to find a referral for head and neck reirradiation. Luckily we now have expert guidelines from the American Radium Society (ARS) on how to approach it. First of all, you probably shouldn’t be offering salvage radiation with curative intent (i.e. high-dose reirradiation) unless you can reasonably expect to achieve a progression-free survival of at least 2 years. Otherwise, a less greuling palliative approach, if anything, is warranted. If done with curative intent, prescriptions should be in the 60-70 Gy range if conventionally fractionated and 35-44 Gy if using a stereotactic radiation (SBRT) approach, and it should be done without inclusion of elective nodes. Finally, all resectable disease should be resected if shooting for a cure, followed by adjuvant  chemoradiation for the typical indications—absent these, adjuvant reirradiation is more controversial. | Ward, Int J Radiat Oncol 2022