A Feasibility Study on Adaptive 18F-FDG-guided Radiotherapy for Recurrent and Second Primary Head and Neck Cancer in the Previously Irradiated Territory.

Inclusion criteria

• Histologically confirmed recurrences and second primary squamous cell carcinoma of the oral cavity, oropharynx, hypopharynx or larynx in the previously irradiated territory.
• Primary unresectable tumor and/or patients refused surgery.
• No grade 3 or more late toxicity (except xerostomia) after the initial radio(chemo)therapy for primary head and neck cancer.
• Minimal interval 12 months after the initial radio(chemo)therapy for primary head and neck cancer.
• Decision of a multidisciplinary tumor board on curative radiotherapy (in combination or not with targeted therapy with cetuximab)
• Karnofsky performance status ≥70%.
• Age ≥ 18 years old.
• Informed consent obtained, signed and dated before specific protocol procedures.

Exclusion criteria

• Previous radiotherapy for cT1-2 cN0 M0 glottic cancer.
• Brachytherapy as treatment for second primary / recurrence.
• Distant metastases.
• Other second primary tumors that are not under control.
• Pregnant or lactating women.
• Elevated blood creatinine level.
• Allergy to the CT-contrast agents.
• Mental condition rendering the patient unable to understand the nature, scope, and possible consequences of the study.
• Patient unlikely to comply with protocol, i.e. uncooperative attitude, inability to return for follow-up visits, and unlikely to complete the study.