Malignancy returns

Recurrence of malignancy is the most dreaded concern, not only for patients but also for their caregivers.[1] Through this poem, we are trying to enlighten our readers about the possibility of cancer recurrence and various options available for its management, to improve the quality of life of such patients. For every cancer recurrence, options include surgery, chemotherapy or radiation Prior to the start of treatment, every case should be put in tumor board for discussion Thirty percent of cases have distant lesions A PET*- CT† scan will clear any confusion If possible, brachytherapy is the first option Salvage surgery is the second option Evaluate the details of past radiation Please take care of the patient’s nutrition Can think of post-operative re-irradiation In case of post-op positive margin and extracapsular extension Triple fusion (CT†-MRI‡-PET *) will help in GTV¦ delineation One centimeter around GTV is adequate for CTV|| delineation Do not irradiate the node prophylactically Unless the node is irradiated previously Do not give stress on the parotid It is time to spare the carotid At second-year post-radiation, the spinal cord recovers by 50 percent Keep the combined BED¶ of the cord to ≤135 Gy for radiation myelitis to prevent Always plan using Intensity Modulated Radiotherapy If the option is available, do Stereotactic Body Radiotherapy If there is an obstruction in deglutition A feeding tube or PEG** is the solution If concurrent chemo does not show any benefit You can try immunotherapy, if the patient is fit Whenever there is any doubt MIRI†† protocol for head and neck re-irradiation will guide you out Hope we have covered everything Lastly, treatment is not complete without counseling (ACRONYMS: *PET = Positron emission tomography; †CT = Computed tomography; ‡MRI = Magnetic resonance imaging; §GTV = Gross tumor volume; ||CTV = Clinical target volume; ¶BED = Biologically effective dose; **PEG = Percutaneous endoscopic gastrostomy; ††MIRI = Multi-institutional re-irradiation). Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.