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Table 4 Grade 4 and 5 severe adverse events

From: A retrospective study of head and neck re-irradiation for patients with recurrent or second primary head and neck cancer: the McGill University experience

Primary site Primary stage Initial treatment Primary response Second diagnosis Interval between first and second diagnosis (months) Life time accumulated dose Toxicity description Interval between second radiation and toxicity (months)
Oropharynx cancer T4N2b Concurrent Platinum-based chemotherapy + radiation 70/35 Gy Complete Local recurrence 17.7 134 Gy Carotid rupture 6 months
Causing death
Maxillary cancer T3N2 Radiation 74/32 Gy Complete Second primary, oropharynx cancer 51.8 144 Gy 1 – osteonecrosis, fractured mandible, disabling; 2 – skin fistula with bone exposed to air 24 months
Oropharynx cancer T2N1 Surgical resection followed by adjuvant radiation of 60 Gy Complete Locoregional recurrence 29 120 Gy Mucositis, 5 × 6 cm ulceration causing bleeding, leading to death 5 months