Interstitial brachytherapy in the management of persistent head and neck disease after definitive external beam radiation therapy.
OBJECTIVE
Persistent disease after definitive external beam radiation therapy for head and neck (H&N) malignancies negatively impacts survival. In this series, the effectiveness of low-dose-rate brachytherapy in the management of persistent H&N disease is explored.


METHODS
All patients who received brachytherapy for persistent H&N disease between 1987 and 2002 were identified. Tumor and treatment characteristics and toxicities were recorded. Progression-free survival and overall survival estimates were generated. The influence of prognostic factors was determined.


RESULTS
Twelve patients were analyzable. Brachytherapy was given curatively (n=4) in patients not amenable to surgery or in combination with surgical dissection to avoid carotid resection (n=8). Seven patients had disease progression with a median time to progression of 11 months (95% confidence interval: 0-22.9). The only negative prognostic factor was time to re-treatment (brachytherapy >4 months) after definitive treatment (p=0.003). Overall survival at 1 and 5 years was 50% and 21%, respectively. Toxicity was limited to one major complication (fistula) and five minor toxicities: low-grade radionecrosis (n=2), cellulitis (n=1), and wound dehiscence (n=2).


CONCLUSIONS
In patients with persistent disease, brachytherapy is an appealing re-treatment alternative. When combined with neck dissection, brachytherapy yields less morbidity than the surgical alternative of carotid resection.
Grimard
Laval
L
Department of Radiation Oncology, The Ottawa Hospital Cancer Centre, Ottawa, ON, Canada. Igrimard@ottawahospital.on.ca
Esche
Bernd
B
Lamothe
André
A
Spaans
Johanna N
JN
D000328:Adult; D000368:Aged; D001918:Brachytherapy / Q000379:methods*; D006258:Head and Neck Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D006801:Humans; D008875:Middle Aged; D011879:Radiotherapy Dosage; D016019:Survival Analysis