Evolving role of salvage reirradiation: Is global harmonization required before treatment guidelines can be developed?

Table 1 Selected results of reirradiation: Both courses external beam radiotherapy unless otherwise specified

Site of ReRT	Symptom overall response rate	Symptom response duration	Overall radiologicresponse rate	Radiologic response duration	Overall survival	Toxicity	% not completing ReRT	ReRT-related death
Head and Neck[24]	NR	NR	NR	NR	44% at 1 yr	23% grade 3+ late at 1 yr	13%	6.7%
Thoracic[21]	Average 69.2%	0.5-5 mo	55%-77% (0-11% CR; 7%-44% PR)	NR	9%-59% at 1 yr	Esophagitis 17.2%	4.5%	1.6%
						Pneumonitis 12.3%
						Skin 4.1%
						Fracture 0.5%
						Myelopathy 0.5%
Breast[25]	100% (56% PR; 44% CR)	"For a long time of the patients' lifetime in the majority"	NR	NR	61% at 1 yr	No grade 3-4 acute or late toxicity	NR	NR
1Pancreas[26]	57% at 1-2 mo	NR	"Tumour stabilization but…not…reduction in tumour size"	NR	Med surv after ReRT 8.8 mo (95%CI: 1.2-16.4 mo)	28% acute grade 2 toxicity (fatigue, abdominal pain, anorexia, nausea, diarrhea)	0%	NR
						No acute grade 3+ toxicity
						6% grade 3 late toxicity
13Cervix[27]	71% achieved ≥ 50% reduction from baseline at 1-2 mo	NR	35% CR, 30% PR, 17% SD, 17% PD at 4 mo	NR	43% at 2 yr	35% mild acute toxicity 13% late grade 4 toxicity (all rectovaginal fistulae requiring colostomy)	NR	NR
1Abdomen/pelvis[28]	95% - pain	NR	100%	NR	52% at 1 yr	0% grade 3-5 acute or late toxicity	NR	NR
	75% - bleeding					Acute 22% grade 1-2 pain
						14% grade 1-2 skin reaction
						8% grade 1-2 diarrhea
						15% grade 1-2 nausea
						4% grade 2 vomiting
						4% grade 1 dysuria
						4% grade 1 dysphagia
						Late 4% grade 2 pain
						4% grade 2 skin reaction
						4% grade 1 diarrhea
						15% grade 1-2 dysuria
						19% grade 1-2 nerve complaints
						11% grade 1-2 limb dysfunction
Bone metastases[18,19]	58%-68% (16%-28% CR; 28%-50% PR)	1-9.7 mo	NR	NR	Median 3-6 mo	30% (nausea, vomiting, fatigue, diarrhea)	NR	NR
Bone metastases[20]	45%-51% of per protocol patients at 2 mo2 (11%-14% CR; 31%-40% PR)	NR	NR	NR	NR	Acute2 skin 14%-24%	NR	0%
						Anorexia 56%-66%
						Vomiting 13%-23%
						Diarrhea 23%-31%
						Late2 Fracture 5%-7%
						Spinal cord compression 1%-2%
						Myelopathy 0%

¹EBRT followed by SBRT;

²Depending on dose;

³7/23 patients in this series did not have EBRT up front but results not reported separately. CR: Complete response; EBRT: External beam radiotherapy; Med surv: Median survival; NR: Not reported; PD: Progressive disease; PR: Partial response; ReRT: Reirradiation; SBRT: Stereotactic body radiotherapy; SD: Stable disease.