title: High-dose-rate brachytherapy plus neck dissection for nodal disease.
abstract: BACKGROUND
  Regional control for advanced nodal disease has been only marginally affected by concurrent chemoradiation, hyperfractionation, concomitant boost, or accelerated external radiation.
  
  
  METHODS
  Twenty-five necks in 24 patients received brachytherapy treatment (20 Gy in 10 twice-daily fractions) in addition to external radiation, neck dissection +/- chemotherapy. Indications for brachytherapy included initial treatment of bulky disease (n = 12), recurrence of neck disease in a previously treated patient with at least a 3-month disease-free interval (n = 6), persistent disease after a curative efforts (n = 4), inadequate external radiation (ie, <40 Gy) due to either intolerance or noncompliance (n = 3).
  
  
  RESULTS
  Overall actuarial regional control was 67% at 2 years. Regional control for those receiving brachytherapy as part of their initial treatment was 82% despite a mean nodal diameter of 8.7 cm (range, 5-15 cm). The 2-year actuarial regional control was 56% for the patients with a disease-free interval of at least 3 years.
  
  
  CONCLUSIONS
  High-dose-rate brachytherapy produced excellent regional control. (c) 2008 Wiley Periodicals, Inc. Head Neck, 2008.
authors.affiliation: Department of Radiation Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York 10471, USA. jbeitler92@alumni.gsb.columbia.edu
authors.forename: Jonathan J
authors.initials: JJ
authors.lastname: Beitler
authors.forename: Madhur
authors.initials: M
authors.lastname: Garg
authors.forename: Randall P
authors.initials: RP
authors.lastname: Owen
authors.forename: Catherine
authors.initials: C
authors.lastname: Sarta
authors.forename: Ravindra
authors.initials: R
authors.lastname: Yaparpalvi
authors.forename: Richard V
authors.initials: RV
authors.lastname: Smith
mesh_terms: D000328:Adult; D000368:Aged; D001918:Brachytherapy / Q000379:methods*; D015331:Cohort Studies; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy*; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology / Q000528:radiation effects*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection / Q000379:methods*; D009361:Neoplasm Invasiveness / Q000473:pathology*; D009367:Neoplasm Staging; D011879:Radiotherapy Dosage; D011882:Radiotherapy, High-Energy; D018570:Risk Assessment; D016019:Survival Analysis; D016896:Treatment Outcome