RESEARCH Open Access Re-irradiation of recurrent o y h

Full list of author information is available at the end of the articlewith concomitant chemotherapy is a curative option for un-resectable recurrences. However, side effects are significant. Randomized or prospective uncontrolled trials with total radiation doses of 60–65 Gy at 1.5- 2.0 Gy per fraction with or without concomitant chemotherapy showed a crude incidence of late grade III or worse side effects of 34 %- 65 % [1-4]. For patients with non-nasopharyngeal head and neck carcinomas treated within these trials, the predominant late side effects were dysfunctions or carotid ruptures. Highly conformal techniques are used frequently. In their large retrospective series, Lee et al. [5] found a higher freedom from loco-regional progression at 2 years with intensity modulated photon radiotherapy techniques in comparison to 3D conformal radiotherapy, indicating that the therapeutic index in the retreatment of head and neck cancer can be improved with more conformal techniques. Recent reviews on proton radiotherapy for head and neck cancer concluded that protons are able to improve the therapeutic ratio by significantly decreasing normal tissue dose, while keeping similar or better target coverage than current photon techniques, and that scanne