Combination of surgical resection and HDR-brachytherapy in patients with recurrent or advanced head and neck carcinomas.
OBJECTIVE
Due to the limited therapeutic options, the management of previously pre-treated recurrent head and neck carcinomas remains a challenging problem. The use of hyper-fractionated-accelerated interstitial high-dose-rate brachytherapy (HDR-BT) might be able to improve safety and survival after surgical resection.


METHODS
From 2000 to 2006, 13 patients with pre-treated, recurrent head and neck cancer (oral, maxillary sinus, lips) were treated in a curative approach by resection the recurrent tumour and HDR-BT. The concept included coverage of the surgical defect and sealing of the brachytherapy applicators with free microvascular or myocutaneous flaps. Conventional radiotherapy and chemotherapy were added as required. The patient group was re-examined with respect to survival and outcome. Additionally 5 patients, who received this combination therapy for primary carcinomas were included in this report observation in order to evaluate the rate of complications and adverse effects.


RESULTS
Kaplan-Meier-curves revealed a 2-year overall survival of 65.3%. The mean survival for recurrent carcinomas was 22.8 months. Patients treated for primary carcinoma had a mean survival of 34.5 months. Four out of five (80%) patients with primary head and neck cancer were alive and without evidence of disease 2 years after treatment. The acute and chronic adverse side effects were manageable. There were no relevant complications concerning tissue transfer.


CONCLUSIONS
Surgical resection combined with HDR-BT can lead to long-lasting remissions. A simultaneous microvascular defect reconstruction provides tissue cover for brachytherapy.
Schiefke
Franziska
F
Department of Oral, Maxillofacial and Facial Plastic Surgery, University of Leipzig, Leipzig, Germany.
Hildebrandt
Guido
G
Pohlmann
Stefan
S
Heinicke
Frank
F
Hemprich
Alexander
A
Frerich
Bernhard
B
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000009:adverse effects / Q000379:methods*; D002294:Carcinoma, Squamous Cell / Q000532:radiotherapy* / Q000601:surgery*; D003131:Combined Modality Therapy; D019583:Dose Fractionation, Radiation; D005260:Female; D006258:Head and Neck Neoplasms / Q000532:radiotherapy* / Q000601:surgery*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008866:Microsurgery; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000532:radiotherapy / Q000601:surgery; D012074:Remission Induction; D012086:Reoperation / Q000009:adverse effects; D016879:Salvage Therapy / Q000379:methods; D013524:Surgical Flaps