title: Interstitial brachytherapy in the management of persistent head and neck disease after definitive external beam radiation therapy.
abstract: 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.
authors.affiliation: Department of Radiation Oncology, The Ottawa Hospital Cancer Centre, Ottawa, ON, Canada. Igrimard@ottawahospital.on.ca
authors.forename: Laval
authors.initials: L
authors.lastname: Grimard
authors.forename: Bernd
authors.initials: B
authors.lastname: Esche
authors.forename: André
authors.initials: A
authors.lastname: Lamothe
authors.forename: Johanna N
authors.initials: JN
authors.lastname: Spaans
mesh_terms: 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