Challenges in recurrent head and neck squamous cell cancer treatment: systematic review and

Background and purpose: Treatment of patients with recurrent head and neck squamous cell cancer in a previously irradiated field remains challenging. We performed a Material and methods: MEDLINE, Cochrane Library, Web of Science, SCOPUS and PsycINFO were systematically searched. The Newcastle-Ottawa Scale was used to assess the risk of bias. A Results: 10 eligible studies with a median follow up of 24.9 months (9.6-78.1) and a total of 958 patients were identified, two of which are prospective trials. 455 were patients treated with post-operative/ adjuvant IMRT (aIMRT), while 503 patients received definitive IMRT (dIMRT). Median age was 62 years (48-63), 78 % were males and the rate of concomitant systemic therapy varied between 0 and 100 %.Post-operative IMRT showed significantly higher 1-year overall survival of 68 %, compared to 55 % for dIMRT, with a risk reduction (RR) of 0.84 (95 % CI: 0.76-0.93). aIMRT achieved superior 1-year locoregional control (65 %) in comparison to dIMRT (58 %) with an RR of 0.89 (95 % CI: 0.798 to 0.997). All other endpoints did not reach statistical significance. The certainty of our findings was low, due to limitations in the included studies. Radiotoxicity was insufficiently reported and does not allow any conclusions. Conclusion: Post-operative IMRT achieves superior survival and tumor control and should be the preferred option for patients eligible for surgery. Careful patient evaluation and selection are fundamental to maximizing therapeutic efficacy while minimizing treatment-related toxicities.