High-dose-rate interstitial brachytherapy in recurrent and previously irradiated head and neck cancers--preliminary results.
OBJECTIVE
Although high-dose-rate brachytherapy (HDRBT) offers significant advantages over low dose rate brachytherapy, there are scant data on improved local control (LC) and treatment-related complications in patients with recurrent head and neck (H&N) cancers. We report our preliminary results in patients with recurrent H&N cancers treated with interstitial HDRBT.


METHODS
Thirty patients with recurrent H&N cancers were treated with HDRBT between September 2003 and October 2005. Seventy-seven percent (23/30) of the patients had either local or regional recurrence in the area of previous external beam radiation therapy. The treatment sites were oral cavity/oropharynx (11/30), neck (10/30), face/nasal cavity (6/30), and parotid bed (3/30). Whereas 18 patients underwent surgical resection followed by HDRBT, 3 patients were treated with combined external beam radiation and HDRBT, and the remaining 9 were treated with HDRBT alone. The dose and fractionation schedules used were 3.4Gy twice per day (b.i.d.) to 34Gy for postoperative cases, 4Gy b.i.d. to 20Gy when combined with 40-50Gy external beam, and 4Gy b.i.d. to 40Gy for definitive treatment. HDRBT was initiated 5 days after catheter placement to allow for tissue healing.


RESULTS
With a median followup of 12 months, 6 local recurrences were observed 1-10 months after the procedure. The 2-year LC and overall survival outcomes for the entire group were 71% and 63%, respectively. Patients treated with surgical resection and HDRBT had an improved 2-year LC compared to the patients treated with HDRBT+/-external beam radiation alone (88% vs. 40%, p=0.05). Six Grade II and four Grade III complications were noted in five patients, all observed in the postoperative HDRBT group.


CONCLUSIONS
The preliminary results of HDRBT indicate an acceptable LC and morbidity in recurrent H&N cancers. A planned surgical resection followed by HDRBT is associated with improved tumor control in these high-risk patients. Based on these encouraging results, prospective clinical trials are warranted using HDRBT in recurrent H&N cancers to decrease late toxicity.
Narayana
Ashwatha
A
Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA. ashwatha.narayana@nyumc.org
Cohen
Gil'ad N
GN
Zaider
Marco
M
Chan
Kelvin
K
Lee
Nancy
N
Wong
Richard J
RJ
Boyle
Jay
J
Shaha
Ashok
A
Kraus
Dennis
D
Shah
Jatin
J
Zelefsky
Michael J
MJ
D000230:Adenocarcinoma / Q000532:radiotherapy; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000009:adverse effects / Q000379:methods; D002280:Basal Cell Carcinoma / Q000532:radiotherapy; D002294:Carcinoma, Squamous Cell / Q000532:radiotherapy; D005260:Female; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000532:radiotherapy* / Q000601:surgery; D017619:Hemibody Irradiation; D006801:Humans; D008297:Male; D008545:Melanoma / Q000532:radiotherapy; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D011832:Radiation Injuries / Q000209:etiology; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D012509:Sarcoma / Q000532:radiotherapy; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome; D047368:Tumor Burden / Q000528:radiation effects