Interstitial brachytherapy in the management of persistent head and neck disease after definitive external beam radiation therapy.

Abstract:

PURPOSE:Persistent disease after definitive external beam radiation therapy for head and neck (H&N) malignancies negatively impacts survival. In this series, the effectiveness of low-dose-rate brachytherapy in the management of persistent H&N disease is explored. METHODS:All patients who received brachytherapy for persistent H&N disease between 1987 and 2002 were identified. Tumor and treatment characteristics and toxicities were recorded. Progression-free survival and overall survival estimates were generated. The influence of prognostic factors was determined. RESULTS:Twelve patients were analyzable. Brachytherapy was given curatively (n=4) in patients not amenable to surgery or in combination with surgical dissection to avoid carotid resection (n=8). Seven patients had disease progression with a median time to progression of 11 months (95% confidence interval: 0-22.9). The only negative prognostic factor was time to re-treatment (brachytherapy >4 months) after definitive treatment (p=0.003). Overall survival at 1 and 5 years was 50% and 21%, respectively. Toxicity was limited to one major complication (fistula) and five minor toxicities: low-grade radionecrosis (n=2), cellulitis (n=1), and wound dehiscence (n=2). CONCLUSION:In patients with persistent disease, brachytherapy is an appealing re-treatment alternative. When combined with neck dissection, brachytherapy yields less morbidity than the surgical alternative of carotid resection.

journal_name

Brachytherapy

journal_title

Brachytherapy

authors

Grimard L,Esche B,Lamothe A,Spaans JN

doi

10.1016/j.brachy.2008.12.007

subject

Has Abstract

pub_date

2009-07-01 00:00:00

pages

284-9

issue

3

eissn

1538-4721

issn

1873-1449

pii

S1538-4721(09)00195-0

journal_volume

8

pub_type

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