High-dose-rate intraoperative brachytherapy and radical surgical resection in the management of recurrent head-and-neck cancer Journal Article


Authors: Teckie, S.; Scala, L. M.; Ho, F.; Wolden, S.; Chiu, J.; Cohen, G. N.; Wong, R.; Ganly, I.; Zelefsky, M. J.; Lee, N. Y.
Article Title: High-dose-rate intraoperative brachytherapy and radical surgical resection in the management of recurrent head-and-neck cancer
Abstract: Purpose: To report long-term outcomes of high-dose-rate (HDR) intraoperative radiotherapy (IORT) at the time of radical resection for recurrent head-and-neck cancer and determine potential prognostic factors. Methods and Materials: Between 7/1998 and 11/2011, 57 patients with recurrent head-and-neck cancer underwent radical resection with curative intent and single-fraction IORT to 59 sites using a Harrison-Anderson-Mick applicator with remotely after-loaded 192Ir HDR brachytherapy. Results: One- and 3-year in-field progression-free survival (IFPFS) was 67% and 57%, respectively. In a multivariate model, IORT dose >15. Gy (hazard ratio [HR] = 0.11; p = 0.02), and prerecurrence disease-free interval >12 months (HR = 0.29; p = 0.04) independently predicted for superior IFPFS; nodal extracapsular extension (HR = 4.62; p = 0.003) predicted for inferior IFPFS. Three-year overall survival (OS) was 50% vs. 32% in those achieving in-field control vs. those not achieving in-field control (. p = 0.04). Grade 3+ toxicity occurred in 37% and was unrelated to IORT dose. Conclusions: HDR-IORT combined with radical surgical resection is associated with durable IFPFS and long-term overall survival in select patients with acceptable treatment-related morbidity. IORT dose >15. Gy should be used to increase the likelihood of disease control. The ability to achieve in-field local control in this poor prognostic cohort was associated with improved survival outcomes. © 2013 American Brachytherapy Society.
Keywords: adolescent; adult; cancer survival; child; controlled study; preschool child; school child; aged; aged, 80 and over; child, preschool; disease-free survival; middle aged; cancer surgery; retrospective studies; young adult; major clinical study; overall survival; cancer localization; carcinoma, squamous cell; fistula; cancer growth; treatment planning; cancer adjuvant therapy; cancer patient; cancer radiotherapy; radiation dose; radiotherapy, adjuvant; recurrent cancer; follow up; follow-up studies; magnetic resonance imaging; antineoplastic agent; progression free survival; neoplasm recurrence, local; radiotherapy dosage; recurrence; tomography, x-ray computed; patient monitoring; radiation injury; fibrosis; dysphagia; whole body imaging; minimal residual disease; head and neck cancer; head and neck neoplasms; intraoperative period; positron-emission tomography; brachytherapy; disease free interval; external beam radiotherapy; cancer control; salvage; trismus; cellulitis; intraoperative radiotherapy; abscess; cranial nerve injury; radical resection; cancer prognosis; distant metastasis free survival; intraoperative radiation therapy
Journal Title: Brachytherapy
Volume: 12
Issue: 3
ISSN: 1538-4721
Publisher: Elsevier Science, Inc.  
Date Published: 2013-05-01
Start Page: 228
End Page: 234
Language: English
DOI: 10.1016/j.brachy.2013.01.165
PROVIDER: scopus
PUBMED: 23466361
DOI/URL:
Notes: --- - "Export Date: 3 June 2013" - "CODEN: BRACC" - "Source: Scopus"
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MSK Authors
  1. Michael J Zelefsky
    647 Zelefsky
  2. Suzanne L Wolden
    431 Wolden
  3. Gilad N Cohen
    139 Cohen
  4. Johnny Chiu
    8 Chiu
  5. Nancy Y. Lee
    562 Lee
  6. Sewit Teckie
    15 Teckie
  7. Richard J Wong
    237 Wong
  8. Ian Ganly
    244 Ganly
  9. Lawrence Matthew Scala
    6 Scala
  10. Felix   Ho
    14 Ho