title: Is there a place for brachytherapy in the salvage treatment of cervical lymph node metastases of head and neck cancers?
abstract: OBJECTIVE
  Therapeutic options are limited for unresectable isolated cervical lymph node recurrences. The purpose of the study was to evaluate the feasibility, safety, and efficacy of high-dose-rate (HDR) and pulsed-dose-rate (PDR) brachytherapy (BT) in such cases.
  
  
  METHODS
  Sixty patients have been analyzed. All them had previously been treated with radical radiotherapy or chemoradiotherapy with or without surgery. PDR-BT and HDR-BT were used in 49 and 11 patients, respectively. In PDR-BT, a dose per pulse of 0.6-0.8 Gy (median 0.7 Gy) was given up to a median total dose of 20 Gy (range, 20-40 Gy). HDR-BT delivered a median total dose of 24 Gy (range, 7-60 Gy) in 3-10 fractions at 3-6 Gy per fraction.
  
  
  RESULTS
  The overall survival and lymph node control rates at 1 and 2 years were estimated for 31.7% and 19%, and 41.4% and 27.3%, respectively. Serious late side effects (soft tissue necrosis) were observed in 11.7% of patients. Adverse events occurred statistically more often in patients >59 years (p = 0.02).
  
  
  CONCLUSIONS
  HDR-BT and PDR-BT are feasible in previously irradiated patients with isolated regional lymph node metastases of head and neck cancers. The techniques should be considered if surgery is contraindicated. They provide acceptable toxicity and better tumor control than chemotherapy alone.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Poznan University of Medical Sciences, Poznan, Poland. Electronic address: annabartochowska@gmail.com.
authors.forename: Anna
authors.initials: A
authors.lastname: Bartochowska
authors.affiliation: Brachytherapy Department, Greater Poland Cancer Center, Poznan, Poland; Electroradiology Department, Poznan University of Medical Sciences, Poznan, Poland.
authors.forename: Janusz
authors.initials: J
authors.lastname: Skowronek
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Poznan University of Medical Sciences, Poznan, Poland.
authors.forename: Malgorzata
authors.initials: M
authors.lastname: Wierzbicka
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Poznan University of Medical Sciences, Poznan, Poland.
authors.forename: Malgorzata
authors.initials: M
authors.lastname: Leszczynska
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Poznan University of Medical Sciences, Poznan, Poland.
authors.forename: Witold
authors.initials: W
authors.lastname: Szyfter
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000009:adverse effects; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000532:radiotherapy* / Q000556:secondary; D019583:Dose Fractionation, Radiation; D005260:Female; D006258:Head and Neck Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009333:Neck; D009336:Necrosis / Q000209:etiology; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000532:radiotherapy*; D011832:Radiation Injuries / Q000209:etiology / Q000473:pathology*; D016879:Salvage Therapy / Q000379:methods*; D015996:Survival Rate
keywords: HDR brachytherapy; Head and neck cancers; Neck recurrence; PDR brachytherapy; Salvage treatment