title: Endoscopy-guided brachytherapy for sinonasal and nasopharyngeal recurrences.
abstract: OBJECTIVE
  To evaluate the preliminary results of perioperative endoscopy-guided brachytherapy (BT) in recurrent sinonasal and nasopharyngeal tumors already treated for their primary tumor with a full course of radiotherapy.
  
  
  METHODS
  Patients with recurrence and already treated with a previous full course of radiotherapy >65 Gy who underwent BT from December 2010 to January 2014 were taken into account for this work. Macroscopic disease was resected by an endoscopic approach, and catheters for BT were endoscopically positioned and fixed at the same time on the surgical bed. Surgery was performed under electromagnetic navigation guidance. The irradiation dose was 30 Gy in 12 fractions, 2.5 Gy each, twice a day, in 6 days.
  
  
  RESULTS
  We performed the endoscopy-guided BT 11 times in 9 patients; in two cases, no previous radiation therapy had been performed; and in one case, followup was too short to be considered. A total of 6 patients were eligible for the analysis. One patient underwent BT three times because of previous target margin recurrences. There were no immediate complications. The median and mean followups were 21 and 19 months, respectively. The median V90 and V85% were 93% and 95%, respectively. In one case, we had a transient deficit of the VI cranial nerve (G3), and in another case, we diagnosed a noncomplicated osteonecrosis (G2). The median disease-free survival is 12 months, and the median overall survival is 23 months.
  
  
  CONCLUSIONS
  The combination of endoscopy and BT seems to be a safe option for treating recurrent sinonasal and nasopharyngeal tumors.
authors.affiliation: Department of Radiation Oncology, Catholic University, Rome, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Tagliaferri
authors.affiliation: Department of Otorhinolaringoiatry, Catholic University, Rome, Italy. Electronic address: ent.brachytherapy@gmail.com.
authors.forename: Francesco
authors.initials: F
authors.lastname: Bussu
authors.affiliation: Department of Otorhinolaringoiatry, Catholic University, Rome, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Rigante
authors.affiliation: Department of Radiation Oncology, Catholic University, Rome, Italy.
authors.forename: Maria Antonietta
authors.initials: MA
authors.lastname: Gambacorta
authors.affiliation: Department of Radiation Oncology, Catholic University, Rome, Italy.
authors.forename: Rosa
authors.initials: R
authors.lastname: Autorino
authors.affiliation: Department of Radiation Oncology, Catholic University, Rome, Italy.
authors.forename: Gian Carlo
authors.initials: GC
authors.lastname: Mattiucci
authors.affiliation: Department of Radiation Oncology, Catholic University, Rome, Italy.
authors.forename: Bruno
authors.initials: B
authors.lastname: Fionda
authors.affiliation: Department of Radiation Oncology, Catholic University, Rome, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Miccichè
authors.affiliation: Physics Institute, Catholic University, Rome, Italy.
authors.forename: Elisa
authors.initials: E
authors.lastname: Placidi
authors.affiliation: Department of Radiation Oncology, Catholic University, Rome, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Balducci
authors.affiliation: Department of Otorhinolaringoiatry, Catholic University, Rome, Italy.
authors.forename: Jacopo
authors.initials: J
authors.lastname: Galli
authors.affiliation: Department of Radiation Oncology, Catholic University, Rome, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Valentini
authors.affiliation: Department of Otorhinolaringoiatry, Catholic University, Rome, Italy.
authors.forename: Gaetano
authors.initials: G
authors.lastname: Paludetti
authors.affiliation: Interdisciplinary Brachytherapy Unit, University of Lübeck & University Hospital S-H, Campus Lübeck, Germany.
authors.forename: Gyoergy
authors.initials: G
authors.lastname: Kovacs
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000379:methods*; D018572:Disease-Free Survival; D004724:Endoscopy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009303:Nasopharyngeal Neoplasms / Q000532:radiotherapy*; D009364:Neoplasm Recurrence, Local / Q000532:radiotherapy*; D010255:Paranasal Sinus Neoplasms / Q000532:radiotherapy*; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted
keywords: Brachytherapy; Endoscopy; HDR; Head and neck cancer; Radiotherapy; Recurrence