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Journal of Contemporary Brachytherapy
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3/2009
vol. 1
 
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Palliative PDR brachytherapy in treatment of recurrent larynx cancer

Janusz Skowronek
,
Adam Chicheł
,
Marek Kanikowski
,
Grzegorz Zwierzchowski

J Contemp Brachyther 2009; 1, 3: 193
Online publish date: 2009/10/08
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Purpose: A large majority of patients with recurrences of larynx cancer are disqualified from radical treatment and constitute a group of bad prognosis. Some of them can be qualified for salvage surgery and treated mostly with a palliative intent. In some cases brachytherapy can be a treatment of choice after previously applied external beam radiotherapy. The paper is to present results of PDR interstitial brachytherapy (PDR-BT) in a described group of patients.
Material and methods: Thirty-eight patients with recurrent larynx cancer were treated with PDR-BT since October 2000 till September 2005 in Greatpoland Cancer Center. The age of patients ranged from 41 to 79 years, average 59.5 years. The group consisted of 5 women (13.2%) and 33 men (86.8%). Clinical locations of tumor before PDR-BT were: metastasis in locoregional lymph node system (n = 22, 57.9%), recurrence in trachestomy area (n = 14, 36.8%) and infiltration of surrounded organs (n = 2, 5.3%). In 37 cases squamous cell carcinoma, in one case – adenocarcinoma were diagnosed. Twenty-nine patients were previously both operated and irradiated (76.3%), 3 were irradiated (7.9%) and 6 were operated (15.8%) as a single modalities. Primary lesions were irradiated most frequently with total dose of 70 Gy. Median time between primary tumor and its recurrent appearance was 15.5 months (min. 3 and max. 48 months) and it was longer than 12 months in 18 cases. Recurrences were treated up to total dose of 20 Gy, most commonly with a single fraction of 20 Gy in 25 pulses by 0.8 Gy hourly. In 5 cases PDR fraction was repeated in view of small size of a tumor and relative good response after first fraction. In 6 cases hyperthermia was added. The assessment of the results was performed in 1st months after completion of the treatment and then after 3, 6 and 12 months. Tolerance of the treatment and acute complications are discussed.
Results: Median survival time carried out 5.3 months (1-8 months). In 1st month after the end of the treatment complete remission (CR) was found in 3 (%), partial remission (PR) in 25 (%) and lack of remission (NR) in 10 (16.7%) cases, respectively. In 3rd and 6th months remission (CR + PR) was observed in (%) and (%) patients, respectively. In 14 cases superficial necrosis was observed in first and third months of observation.
Conclusions:
1. PDR brachytherapy can be a treatment of choice in patients previously irradiated with external beam radiotherapy and/or surgery.
2. It appears to be, that in case of infiltrating the tracheostomy area PDR brachytherapy can prolong overall survival time.
3. To confirm the above a comparative investigation of a larger group of patients is needed.
Copyright: © 2009 Termedia Sp. z o. o. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International (CC BY-NC-SA 4.0) License (http://creativecommons.org/licenses/by-nc-sa/4.0/), allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material, provided the original work is properly cited and states its license.
 
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