title: Reirradiation for recurrent head and neck cancer with salvage interstitial pulsed-dose-rate brachytherapy: Long-term results.
abstract: OBJECTIVE
  To assess the long-term results of protocol-based interstitial pulsed-dose-rate (PDR) brachytherapy as reirradiation combined with simultaneous chemotherapy and interstitial hyperthermia in selected patients with recurrent head and neck tumors.
  
  
  METHODS
  A total of 104 patients with biopsy-proven recurrent head and neck cancer were treated with interstitial PDR brachytherapy. Salvage surgery had also been undergone by 53/104 (51%) patients (R1 or R2 resection in > 80% of patients). Salvage brachytherapy alone was administered in 81 patients (78%), with a median total dose of 56.7 Gy. Salvage brachytherapy in combination with external beam radiotherapy (EBRT) was performed in 23/104 patients (32%), using a median total dose of DREF = 24 Gy. Simultaneously to PDR brachytherapy, concomitant chemotherapy was administered in 58/104 (55.8%) patients. A single session of interstitial hyperthermia was also used to treat 33/104 (31.7%) patients. The analysis was performed after a median follow-up of 60 months.
  
  
  RESULTS
  Calculated according to Kaplan-Meier, local tumor control rates after 2, 5, and 10 years were 92.5, 82.4, and 58.9%, respectively. Comparing results of salvage PDR brachytherapy with or without simultaneous chemotherapy, the 10-year local control rates were 76 vs. 39% (p = 0014), respectively. No other patient- or treatment-related parameters had a significant influence on treatment results. Soft tissue necrosis or bone necrosis developed in 18/104 (17.3%) and 11/104 (9.6%) patients, respectively, but only 3% of patients required surgical treatment.
  
  
  CONCLUSIONS
  PDR interstitial brachytherapy with simultaneous chemotherapy is a very effective and, in experienced hands, also a safe treatment modality in selected patients with head and neck cancer in previously irradiated areas.
authors.affiliation: Dept. of Radiation Oncology, University Hospital Erlangen, Universitätsstr. 27, 91052, Erlangen, Germany, vratislav.strnad@uk-erlangen.de.
authors.forename: Vratislav
authors.initials: V
authors.lastname: Strnad
authors.forename: Michael
authors.initials: M
authors.lastname: Lotter
authors.forename: Stephan
authors.initials: S
authors.lastname: Kreppner
authors.forename: Rainer
authors.initials: R
authors.lastname: Fietkau
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000379:methods*; D017024:Chemotherapy, Adjuvant / Q000379:methods*; D003131:Combined Modality Therapy; D019583:Dose Fractionation, Radiation; D005260:Female; D006258:Head and Neck Neoplasms / Q000628:therapy*; D006801:Humans; D006979:Hyperthermia, Induced / Q000379:methods*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000628:therapy*; D016879:Salvage Therapy / Q000379:methods*; D016896:Treatment Outcome