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The median time between the two radiation courses was 53 months.
Therefore, no patient experienced toxicity higher than grade 3. The treatment-related cumulative cutaneous side effects were graded according to CTC 3.0 and documented for both radiation courses.
Since the first radiation treatment was performed before the definition of CTC criteria, all data from medical charts were reviewed and converted into CTC 3.0 criteria to compare maximal occurred cumulative toxicity at first and second radiation courses.
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The choice for reirradiation in recurrent or persistent head and neck tumors after a previous full radiation course should be considered carefully.
Time to any failure after the second radiation course was defined as the time from start of re-irradiation, in order to compare patients with and without excision.
Maximal cumulated late toxicity of the first radiation course was assessed at last follow-up before treatment or at baseline examination before re-treatment.
Radiation-induced pneumonitis was observed after re-irradiation in four patients (twice grade 1 and 2) in contrast to one case of pneumonitis (grade 1) during the first radiation course.
The favourable toxicity profile led to good compliance with treatment, and the full radiation course was delivered to all but two patients, and only four patients stopped chemotherapy because of toxicity.
All patients complained of slight to moderate dysphagia and/or odynophagia at the end of the third week of the radiation course (T2, 30 Gy) but no patients developed grade 2 acute toxicity.
However, challenging problems exist for tumor reirradiation such as the risk of normal tissue toxicity in the reirradiation situation and the radioresistance of tumor clonogens which persist through the initial radiation course.
In particular, the Italian ELIOT trial appeared a promising feature in early breast cancer treated with breast-conserving surgery, reducing the exposure of normal tissues to radiations and shortening the radiation course from 6 weeks to one single session (Veronesi et al, 2010).
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