How would you treat a second HPV related oropharyngeal squamous cell cancer in a patient previoulsy treated and cured of a HPV related SCC of the tonsil treated with chemoradiation?  

At our institution, recurrent or second primary head and neck cancers are discussed at a multidisciplinary tumor board whenever possible. We review prior radiation records, physician's notes, and pre-treatment imaging to attempt to come to a consensus whether it is truly a second primary or perhaps ...

I actually had this case in my practice a few years ago. The T1 second primary was a marginal recurrence, not fully in the prior treatment field. I elected to treat the second primary with a margin (no nodal coverage since both necks previously irradiated) with fractionated IMRT, 70Gy in 35 fraction...

In general, resectable LR recurrences of HPV+ OPC after chemo-RT should be treated by definitive surgery. We treat non-resectable recurrences or new primary tumors in previously irradiated fields with re-RT. Re-RT using SBRT or standard fractionated chemo-RT provide quite similar results regarding b...

Agree with Dr. @Julie J. Kang. Would emphasize her point about avoiding prophylactic targets in re-RT. In our institution, of 66 pts re-treated to targets consisting of only the recurrent GTV with close margins, almost all LRR occurred within the irradiated targets. Popovtzer et al., PMID 19135312