title: Re-irradiation with interstitial pulsed-dose-rate brachytherapy for unresectable recurrent head and neck carcinoma.
abstract: OBJECTIVE
  To assess the long-term results of protocol-based interstitial pulsed-dose-rate (PDR) brachytherapy combined with simultaneous chemotherapy in selected patients with recurrent head and neck tumors not amenable to salvage surgery.
  
  
  METHODS
  A total of 51 patients with recurrent head and neck cancer were treated with interstitial PDR brachytherapy. Forty patients (78%) had salvage brachytherapy alone using a median total dose of 60 Gy. Salvage brachytherapy in combination with external beam therapy was performed in 11 patients (22%) using a median total dose of DREF=27 Gy. Simultaneously with the PDR brachytherapy, a concomitant chemotherapy was administered in 35/51 (69%) of patients. The analysis was performed after a median followup of 58 months.
  
  
  RESULTS
  Local control rates calculated according to Kaplan-Meier after 2 and 5 years were 71% and 57%, respectively. Comparing results of salvage PDR brachytherapy with or without simultaneous chemotherapy, the 5-year local recurrence-free survival rates were 78.9% vs. 38.5% (p=0.01), respectively. No other patient or treatment-related parameters had a significant influence on treatment results. A total of 9/51 (17.7%) and 6/51 (11.8%) patients developed soft-tissue necrosis or bone necrosis, respectively, but only 2% of patients required surgical treatment.
  
  
  CONCLUSIONS
  PDR interstitial brachytherapy with pulse doses between 0.4 and 0.7 Gy/h/24 h with simultaneous chemotherapy is an effective and safe option for curative therapy in selected patients with head and neck cancer in previously irradiated areas, which are not suitable for salvage surgery.
authors.affiliation: Department of Radiation Oncology, University Hospital Erlangen, Erlangen, Germany. Electronic address: vratislav.strnad@uk-erlangen.de.
authors.forename: Vratislav
authors.initials: V
authors.lastname: Strnad
authors.affiliation: Department of Radiation Oncology, University Hospital Erlangen, Erlangen, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Lotter
authors.affiliation: Department of Radiation Oncology, University Hospital Erlangen, Erlangen, Germany.
authors.forename: Stephan
authors.initials: S
authors.lastname: Kreppner
authors.affiliation: Department of Radiation Oncology, University Hospital Erlangen, Erlangen, Germany.
authors.forename: Rainer
authors.initials: R
authors.lastname: Fietkau
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001842:Bone and Bones / Q000473:pathology / Q000528:radiation effects; D001918:Brachytherapy / Q000379:methods; D002294:Carcinoma, Squamous Cell / Q000532:radiotherapy*; D005260:Female; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000532:radiotherapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009336:Necrosis / Q000209:etiology; D009364:Neoplasm Recurrence, Local / Q000532:radiotherapy*; D011832:Radiation Injuries; D011879:Radiotherapy Dosage; D016879:Salvage Therapy; D000077195:Squamous Cell Carcinoma of Head and Neck
keywords: Head and neck cancer; Interstitial brachytherapy; Local recurrence; PDR brachytherapy; Re-irradiation; Salvage brachytherapy