title: High-dose-rate intraoperative brachytherapy and radical surgical resection in the management of recurrent head-and-neck cancer.
abstract: OBJECTIVE
  To report long-term outcomes of high-dose-rate (HDR) intraoperative radiotherapy (IORT) at the time of radical resection for recurrent head-and-neck cancer and determine potential prognostic factors.
  
  
  METHODS
  Between 7/1998 and 11/2011, 57 patients with recurrent head-and-neck cancer underwent radical resection with curative intent and single-fraction IORT to 59 sites using a Harrison-Anderson-Mick applicator with remotely after-loaded (192)Ir HDR brachytherapy.
  
  
  RESULTS
  One- and 3-year in-field progression-free survival (IFPFS) was 67% and 57%, respectively. In a multivariate model, IORT dose >15Gy (hazard ratio [HR] = 0.11; p = 0.02), and prerecurrence disease-free interval >12 months (HR = 0.29; p = 0.04) independently predicted for superior IFPFS; nodal extracapsular extension (HR = 4.62; p = 0.003) predicted for inferior IFPFS. Three-year overall survival (OS) was 50% vs. 32% in those achieving in-field control vs. those not achieving in-field control (p = 0.04). Grade 3+ toxicity occurred in 37% and was unrelated to IORT dose.
  
  
  CONCLUSIONS
  HDR-IORT combined with radical surgical resection is associated with durable IFPFS and long-term overall survival in select patients with acceptable treatment-related morbidity. IORT dose >15Gy should be used to increase the likelihood of disease control. The ability to achieve in-field local control in this poor prognostic cohort was associated with improved survival outcomes.
authors: Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY10065, USA. teckies@mskcc.org
authors: Sewit
authors: S
authors: Teckie
authors: L Matthew
authors: LM
authors: Scala
authors: Felix
authors: F
authors: Ho
authors: Suzanne
authors: S
authors: Wolden
authors: Johnny
authors: J
authors: Chiu
authors: Gil'ad N
authors: GN
authors: Cohen
authors: Richard
authors: R
authors: Wong
authors: Ian
authors: I
authors: Ganly
authors: Michael J
authors: MJ
authors: Zelefsky
authors: Nancy Y
authors: NY
authors: Lee
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000379:methods*; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis / Q000532:radiotherapy / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000175:diagnosis / Q000532:radiotherapy / Q000601:surgery*; D006801:Humans; D007432:Intraoperative Period; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000532:radiotherapy / Q000601:surgery*; D049268:Positron-Emission Tomography; D011379:Prognosis; D011879:Radiotherapy Dosage; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D000077195:Squamous Cell Carcinoma of Head and Neck; D014057:Tomography, X-Ray Computed; D051598:Whole Body Imaging / Q000379:methods; D055815:Young Adult