Reirradiation of head and neck cancer with high-dose-rate brachytherapy: a customizable intraluminal solution for postoperative treatment of tracheal mucosa recurrence.
OBJECTIVE
Delivering adequate dose to tracheal mucosa recurrence after multiple prior courses of surgery and radiation presented a challenge for radiation delivery. Tumor bed location and size, combined with previous doses to surrounding areas, complicated the use of external beam therapy with either photons or electrons. High-dose-rate (HDR) brachytherapy was explored to provide sufficient dose coverage.


METHODS
A 45-year-old gentleman presented with recurrent head and neck cancer. After undergoing additional excision of gross tumor in the tracheal region, radiation was recommended to improve local control. The region of residual tumor was confined to a small superficial lesion at the posterior-superior aspect of the trachea, involving mucosa located along the bend of the trachea, immediately deep to the stoma. External beam treatment was discussed but was not recommended based on recurrence location in the prior radiation field and patient's flexed chin position. HDR technique with a custom applicator was preferred.


RESULTS
A three-dimensional HDR plan based on computed tomography used a single catheter optimized to cover gross tumor volume as delineated by physician. Prescribed dose was 5 Gy/fraction for six fractions (two fractions/wk). The applicator position was verified daily with computed tomography and physician setup approval before treatment. The patient was positioned on a wing board to allow access to the stoma. HDR brachytherapy was well tolerated.


CONCLUSIONS
Intraluminal HDR brachytherapy is a viable option for providing dose to region inside tracheal stoma. Advantages over photon and electron beam therapy include reduced dose to surrounding tissues previously irradiated, skin dose, and reproducibility of treatment delivery.
Doyle
Laura A
LA
Department of Radiation Oncology, Bodine Center for Cancer Treatment, Jefferson Medical College of Thomas Jefferson University, Philadelphia 19107, PA, USA. Laura.doyle@jeffersonhospital.org
Harrison
Amy S
AS
Cognetti
David
D
Xiao
Ying
Y
Yu
Yan
Y
Liu
Haisong
H
Ahn
Peter H
PH
Anné
P Rani
PR
Showalter
Timothy N
TN
D001918:Brachytherapy / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000532:radiotherapy* / Q000601:surgery*; D011182:Postoperative Care / Q000379:methods; D020545:Respiratory Mucosa / Q000528:radiation effects*; D014134:Tracheal Neoplasms / Q000532:radiotherapy* / Q000601:surgery*; D016896:Treatment Outcome