High-dose-rate intraoperative radiation therapy for recurrent head-and-neck cancer Journal Article

Authors: Perry, D. J.; Chan, K.; Wolden, S.; Zelefsky, M. J.; Chiu, J.; Cohen, G.; Zaider, M.; Kraus, D.; Shah, J.; Lee, N.
Article Title: High-dose-rate intraoperative radiation therapy for recurrent head-and-neck cancer
Abstract: Purpose: To report the use of high-dose-rate intraoperative radiation therapy (HDR-IORT) for recurrent head-and-neck cancer (HNC) at a single institution. Methods and Materials: Between July 1998 and February 2007, 34 patients with recurrent HNC received 38 HDR-IORT treatments using a Harrison-Anderson-Mick applicator with Iridium-192. A single fraction (median, 15 Gy; range, 10-20 Gy) was delivered intraoperatively after surgical resection to the region considered at risk for close or positive margins. In all patients, the target region was previously treated with external beam radiation therapy (median dose, 63 Gy; range, 24-74 Gy). The 1- and 2-year estimates for in-field local progression-free survival (LPFS), locoregional progression-free survival (LRPFS), distant metastases-free survival (DMFS), and overall survival (OS) were calculated. Results: With a median follow-up for surviving patients of 23 months (range, 6-54 months), 8 patients (24%) are alive and without evidence of disease. The 1- and 2-year LPFS rates are 66% and 56%, respectively, with 13 (34%) in-field recurrences. The 1- and 2-year DMFS rates are 81% and 62%, respectively, with 10 patients (29%) developing distant failure. The 1- and 2-year OS rates are 73% and 55%, respectively, with a median time to OS of 24 months. Severe complications included cellulitis (5 patients), fistula or wound complications (3 patients), osteoradionecrosis (1 patient), and radiation-induced trigeminal neuralgia (1 patient). Conclusions: HDR-IORT has shown encouraging local control outcomes in patients with recurrent HNC with acceptable rates of treatment-related morbidity. Longer follow-up with a larger cohort of patients is needed to fully assess the benefit of this procedure. © 2010 Elsevier Inc. All rights reserved.
Keywords: adolescent; adult; cancer survival; child; clinical article; preschool child; school child; aged; aged, 80 and over; disease-free survival; middle aged; cancer surgery; treatment failure; young adult; overall survival; cancer recurrence; carcinoma, squamous cell; cancer growth; cancer radiotherapy; radiation dose; follow up; progression free survival; neoplasm recurrence, local; radiation; radiotherapy dosage; radiotherapy; oncology; distant metastasis; head and neck cancer; head and neck neoplasms; intraoperative period; surgical resection; local control; external beam radiotherapy; head and neck; osteoradionecrosis; bone necrosis; iridium 192; iridium radioisotopes; cellulitis; head-and-neck cancer; high-dose-rate brachytherapy; recurrent; trigeminus neuralgia; high dose rate; external beam radiation therapy; reirradiation; radiation-induced; intraoperative radiation; andersons; high-dose rate brachytherapy; in-field; in-field recurrence; intraoperative radiation therapies; iridium-192; target regions; treatment-related morbidities; trigeminal neuralgia; iridium; surgical wound
Journal Title: International Journal of Radiation Oncology, Biology, Physics
Volume: 76
Issue: 4
ISSN: 0360-3016
Publisher: Elsevier Inc.  
Date Published: 2010-03-15
Start Page: 1140
End Page: 1146
Language: English
DOI: 10.1016/j.ijrobp.2009.03.025
PUBMED: 19560882
PROVIDER: scopus
Notes: --- - "Export Date: 20 April 2011" - "CODEN: IOBPD" - "Source: Scopus"
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MSK Authors
  1. Michael J Zelefsky
    655 Zelefsky
  2. Dennis Kraus
    266 Kraus
  3. Suzanne L Wolden
    438 Wolden
  4. Gilad N Cohen
    139 Cohen
  5. Johnny Chiu
    8 Chiu
  6. Nancy Y. Lee
    582 Lee
  7. David James Perry
    3 Perry
  8. Marco Zaider
    169 Zaider
  9. Jatin P Shah
    567 Shah
  10. Kelvin Chan
    19 Chan