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Adequate tumor dose coverage was important for treating rT3 to rT4 NPC. Although late complications were common, treatment-related mortality was solely vascular in nature. Dose constraints of neurologic structures for reirradiation should be revised with the latest information on late toxicities. © 2016 Wiley Periodicals, Inc. Head Neck 39: 533-540, 2017.

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Conclusion: Three percent of head and neck cancer patients who received radical RT developed grade 3 osteonecrosis. Tumor location and radiation dose are important factors that determine osteonecrosis, but modern RT technique may decrease the risk.