ntraoperative radiotherapy (IORT) an innovative technique that assures the delivery of radiation immediately after surgical resection and thus directly on tumor bed, without the necessity of excessive radiation protection measures. The clinical data regarding the use of IORT in head and neck cancer are little and a comprehensive and evidence-based analysis of recurrent head and neck cancer is still pending. Despite an aggressive multidisciplinary management, in head and neck cancer it is difficult to achieve long term control and approximately 30% of patients, especially those with locally advanced disease at diagnosis, develop loco-regional failure. Independently of primary location, the vast majority of recurrences occurs at or adjacent to the original tumor site