eISSN: 2081-2841
ISSN: 1689-832X
Journal of Contemporary Brachytherapy
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5/2018
vol. 10
 
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abstract:
Original paper

High-dose-rate interstitial brachytherapy in recurrent head and neck cancer: an effective salvage option

Rajendra Bhalavat, Vibhay Pareek, Manish Chandra, Lalitha Nellore, Karishma George, Dipalee Borade, Ketan Kalariya, Zaiba Moosa, Amrita Srivastava, Navaneeth Reddy, Ankita Kapoor, Darshana Kawale, Nandakumar P., Pratibha Bauskar

J Contemp Brachytherapy 2018; 10, 5: 425–430
Online publish date: 2018/10/15
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Purpose
High-dose-rate (HDR) interstitial brachytherapy has an established role in head and neck malignancies and offers good survival rates; however, there is scant data on improved local control (LC) and treatment-related complications in recurrent cases. We present our results in patients with recurrent head and neck cancers treated with HDR interstitial brachytherapy.

Material and methods
Twenty-five patients with recurrent head and neck cancers were treated with HDR interstitial brachytherapy using Iridium 192 between 2009 and 2016. Of these, 75% received radical brachytherapy, and 25% received external beam radiation therapy (EBRT) followed by brachytherapy boost. Treatment sites included oral cavity (15/25) and oropharynx (10/25). Median dose of 4.5 Gy was administered twice per day, with median total brachytherapy dose of 40.5 Gy in radical and 27 Gy for EBRT cases

Results
With median follow-up of 25 months, 4 local recurrences were observed within first year of follow-up. Two-year local control and overall survival outcomes for the entire group were 75% and 68%, respectively. Local control rate with radical BRT vs. BRT as a boost following EBRT was found to be significant (2-year LCR 62% vs. 85%; p < 0.02). Dosimetric assessment revealed D90 – 4.08 Gy, V100 – 94.1%, V150 – 24.7%, and V200 – 10.1%. Xerostomia, altered taste, and dysphagia were the major complications commonly grade 1 and 2. Grade 3 toxicity was only 2%. Pre-treatment volume > 85 cc had a negative impact on overall survival (26 months vs. 12 months; p = 0.02), and interval time between primary and recurrence more than 15 months had an impact on the local control rate (p < 0.01).

Conclusions
Results of HDR interstitial brachytherapy have shown acceptable local control and overall survival rates along with tolerable toxicities and morbidity in recurrent head and neck cancers.

keywords:

HDR brachytherapy, head and neck cancer, recurrent tumor

 
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