title: Perioperative high dose rate brachytherapy (PHDRB) in previously irradiated head and neck cancer: Results of a phase I/II reirradiation study.
abstract: This study was undertaken to determine the feasibility of salvage surgery and PHDRB in patients with previously irradiated, recurrent head and neck cancer or second primary tumors arising in a previously irradiated field.
  
  
  
  Sixty-three patients were treated with surgical resection and PHDRB. The PHDRB dose was 4Gy b.i.d.×8 (32Gy) for R0 resections and 4Gy b.i.d.×10 (40Gy) for R1 resections, respectively. Further external beam radiotherapy or chemotherapy was not given.
  
  
  
  Resections were categorized as R0 in 7 patients (11.1%) and R1 in 56 (88.9%). Thirty-four patients with R1 resections (54.0%) had microscopically positive margins, and 22 patients (34.9%) had close margins. Thirty-two patients (50.8%) developed RTOG grade 3 or greater adverse events including 3 fatal events. After a median follow-up of 6.8years, the 5-year locoregional control rate and 5-year overall survival rates were 55.0% and 35.6%, respectively.
  
  
  
  Surgical resection and PHDRB is a successful treatment strategy in selected patients with previously irradiated head and neck cancer. Long-term locoregional control can be achieved in a substantial number of cases despite a high rate of inadequate surgical resections although at the expense of substantial toxicity.
authors.affiliation: Department of Oncology, Clínica Universidad de Navarra, Spain.
authors.forename: Maria Isabel
authors.initials: MI
authors.lastname: Martínez-Fernández
authors.affiliation: Department of Otolaryngology, Clínica Universidad de Navarra, Spain.
authors.forename: Juan
authors.initials: J
authors.lastname: Alcalde
authors.affiliation: Department of Oncology, Clínica Universidad de Navarra, Spain.
authors.forename: Mauricio
authors.initials: M
authors.lastname: Cambeiro
authors.affiliation: Department of Oncology, Clínica Universidad de Navarra, Spain.
authors.forename: German Valtueña
authors.initials: GV
authors.lastname: Peydró
authors.affiliation: Department of Oncology, Clínica Universidad de Navarra, Spain. Electronic address: rmartinezm@unav.es.
authors.forename: Rafael
authors.initials: R
authors.lastname: Martínez-Monge
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006258:Head and Neck Neoplasms / Q000401:mortality / Q000532:radiotherapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011879:Radiotherapy Dosage; D000069475:Re-Irradiation; D016879:Salvage Therapy; D015996:Survival Rate
keywords: Brachytherapy; Head and neck cancer; High dose rate; Perioperative; Prior radiation therapy; Reirradiation