title: Intra-operative radiotherapy--5 years of experience in the palliative treatment of recurrent and advanced head and neck cancers.
abstract: Recurrent and advanced cancer in the head and neck region is usually associated with limited therapeutic concepts and a dismal prognosis. Efforts mainly focus on palliative treatment in order to improve the patient's quality of life. From May 1989 to December 1994, a total of 120 intra-operative radiotherapy (IORT) procedures with high-energy electron beams (mean energy: 7 MeV: mean dose: 20 Gy) were performed in 95 patients. Therapy was usually performed under endotracheal anaesthesia (84%). There were 91 cases (75.8%) of recurrence in the lymph nodes of the neck and 14 cases (11.7%) of local recurrence. 15 patients (12.5%) received IORT as part of the initial treatment. Considering the palliative nature of IORT in these patients, only an R2 resection (gross residual tumour) was achieved in 71.7%. Local tumour control was nonetheless possible in 17% (R2 resection) to 64% (complete R0 resection), with a mean 11-month follow-up period for survivors (mean for deceased patients: 8 months). Regarding palliative criteria, IORT proved to be feasible since patients profited from short hospitalisation (median: 10 days), a low complication rate (27 instances; e.g. tracheostomy: 11; necrosis: 8, or fistula: 3) and, in part, a substantial reduction of pain (73.8%). Most of them regained physical and psychic integrity for weeks to months and were able to take part in social life during the final stage of their disease.
authors.affiliation: Department of Otorhinolaryngology, Head and Neck Plastic Surgery, Technical University, Aachen, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Spaeth
authors.forename: D
authors.initials: D
authors.lastname: Andreopoulos
authors.forename: T
authors.initials: T
authors.lastname: Unger
authors.forename: J
authors.initials: J
authors.lastname: Beckman
authors.forename: J
authors.initials: J
authors.lastname: Ammon
authors.forename: G
authors.initials: G
authors.lastname: Schlöndorff
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006258:Head and Neck Neoplasms / Q000532:radiotherapy* / Q000556:secondary / Q000601:surgery*; D006801:Humans; D007430:Intraoperative Care; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D009367:Neoplasm Staging; D010166:Palliative Care / Q000379:methods*; D011879:Radiotherapy Dosage; D018714:Radiotherapy, Adjuvant; D016896:Treatment Outcome