Squamous cell carcinoma of the head and neck occurs frequently worldwide, with more than 500,000 new cases projected annually. Once recurrent after primary treatment, survival rates for head and neck cancers are very poor. Management of recurrent head and neck cancer is a seldom reported but a common clinical dilemma. Only a small subset of patients are candidates for potentially curative surgery. Chemotherapy alone provides only limited palliation with no long-term survivors, and reirradiation in most cases is unfeasible because of local toxicity. Experience is accumulating using laser-induced thermal therapy (LITT) for treatment of recurrent, unresectable head and neck cancers leading to favorable results and apparent long-term efficacy in some cases. In this study, we review our results on 104 patients with recurrent head and neck cancer who were treated by LITT. Best results were seen in oral cavity tumors where average survival was 20.3 months (10.7-30 months; 95% CI) compared to neck (average = 14.4 months, 7.5-20.7 months; 95% CI) and other tumor sites (average = 18 months, 13.8-22.3 months; 95% CI). Tumor regrowth was not seen after treatment for an average of 47 days, with significant palliation of symptoms observed in most of these patients. Therapy response was inversely related to initial tumor volume and was dependent on both histology and growth rate. Smaller slow-growing tumors and more differentiated tumors were palliated successfully with a better local therapy response rate than poorly differentiated and rapidly dividing malignancies. The results of LITT in recurrent head and neck cancer and the prognostic factors predicting outcome in this patient population are also reviewed.
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