Brachytherapy in the retreatment of patients with new primary head and neck cancer.
OBJECTIVE
Re-treatment for cure of the Head and Neck (H&N) region is therapeutically challenging. In this review we explore the long-term results of Ir(192) low-dose-rate (LDR) brachytherapy in the select subgroup of patients treated for a new H&N malignancy.


METHODS
Thirteen patients received brachytherapy between 1987-2004 for a new primary H&N cancer, six of whom had been retreated previously. Brachytherapy was given as a monotherapy in eight patients and delivered adjuvantly in five patients. Three of the thirteen patients had advanced disease at the time of diagnosis.


METHODS
In addition to the known prognostic factors of stage and site, intent of brachytherapy and prior re-treatment status were assessed for their influence on local control (LC) and overall survival (OS).


RESULTS
Local control differed by disease stage of the new primary tumor. With a median follow-up of 50 months, mean progression-free survival was 50.2 months [95%CI = 30.1-70.4] and the 2-year rate of LC was 58%. Adjuvant brachytherapy following surgery resulted in poor LC and OS due to advanced disease at diagnosis. Prior retreatment did not appear to affect LC or OS. OS at 2 and 5 years was 69% and 38%, respectively. There were no cases of grade III toxicity.


CONCLUSIONS
LDR Brachytherapy for a new primary H&N cancer is a well-tolerated retreatment alternative that results in good local control. Our results suggest that the best chance for long-term survival remains in the routine follow-up and early diagnosis of the new H&N malignancy.
Grimard
Laval
L
Department of Radiation Oncology, The Ottawa Hospital Regional Cancer Centre, Ottawa, ON, Canada.
Lamothe
André
A
Esche
Bernd
B
Spaans
Johanna N
JN
D000328:Adult; D000368:Aged; D001918:Brachytherapy / Q000379:methods*; D018450:Disease Progression; D005260:Female; D006258:Head and Neck Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000532:radiotherapy*; D009367:Neoplasm Staging; D019233:Retreatment; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome