High-dose-rate brachytherapy plus neck dissection for nodal disease.
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.
Beitler
Jonathan J
JJ
Department of Radiation Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York 10471, USA. jbeitler92@alumni.gsb.columbia.edu
Garg
Madhur
M
Owen
Randall P
RP
Sarta
Catherine
C
Yaparpalvi
Ravindra
R
Smith
Richard V
RV
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