Réirradiations des carcinomes épidermoïdes des voies aérodigestives supérieures : indications et résultats

Resume Malgre les progres dans la prise en charge des carcinomes epidermoides des voies aerodigestives superieures (VADS), de nombreux patients vont developper une recidive en territoire irradie ou un second primitif. Devant la tres grande heterogeneite de ces patients, des facteurs lies a la maladie (localisation, volume, recidive ou second primitif, intervalle depuis la premiere irradiation, etc.), des facteurs lies au patient (comorbidites, sequelles de la premiere irradiation…), les indications sont posees au cas par cas. Les donnees historiques de reirradiation, bien que rapportant des donnees d’efficacite parfois encourageantes, font etat de taux de toxicite de grades 4 et 5 importants. Avec la generalisation recente des techniques de radiotherapie plus precises et mieux conformees comme la radiotherapie conformationnelle avec modulation d’intensite (RCMI) ou la radiotherapie stereotaxique (SBRT), le rapport benefice/risque de la reirradiation a evolue ces dernieres annees. L’objectif de cette revue est de faire le point sur les reirradiations des carcinomes epidermoides des voies aerodigestives superieures en termes de selection de patients, et de techniques modernes de radiotherapie.

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