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Title: Intraoperative radiation therapy for recurrent head-and-neck cancer: The UCSF experience

Abstract

Purpose: To review a single-institutional experience with the use of intraoperative radiation therapy (IORT) for recurrent head-and-neck cancer. Methods and Materials: Between 1991 and 2004, 137 patients were treated with gross total resection and IORT for recurrence or persistence of locoregional cancer of the head and neck. One hundred and thirteen patients (83%) had previously received external beam radiation as a component of definitive therapy. Ninety-four patients (69%) had squamous cell histology. Final surgical margins were microscopically positive in 56 patients (41%). IORT was delivered using either a modified linear accelerator or a mobile electron unit and was administered as a single fraction to a median dose of 15 Gy (range, 10-18 Gy). Median follow-up among surviving patients was 41 months (range, 3-122 months). Results: The 1-year, 2-year, and 3-year estimates of in-field control after salvage surgery and IORT were 70%, 64%, and 61%, respectively. Positive margins at the time of IORT predicted for in-field failure (p = 0.001). The 3-year rates of locoregional control, distant metastasis-free survival, and overall survival were 51%, 46%, and 36%, respectively. There were no perioperative fatalities. Complications included wound infection (4 patients), orocutaneous fistula (2 patients), flap necrosis (1 patient), trismus (1 patient), andmore » neuropathy (1 patient). Conclusions: Intraoperative RT results in effective disease control with acceptable toxicity and should be considered for selected patients with recurrent or persistent cancers of the head and neck.« less

Authors:
 [1];  [2];  [3];  [4];  [5];  [2];  [2]
  1. Department of Radiation Oncology, University of California, San Francisco, Comprehensive Cancer Center, San Francisco, CA (United States). E-mail: allenmchen@yahoo.com
  2. Department of Radiation Oncology, University of California, San Francisco, Comprehensive Cancer Center, San Francisco, CA (United States)
  3. Department of Otolaryngology, Head and Neck Surgery, University of California, San Francisco, Comprehensive Cancer Center, San Francisco, CA (United States)
  4. Department of Pathology, University of California, San Francisco, Comprehensive Cancer Center, San Francisco, CA (United States)
  5. Department of Otolaryngology, Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA (United States)
Publication Date:
OSTI Identifier:
20850304
Resource Type:
Journal Article
Resource Relation:
Journal Name: International Journal of Radiation Oncology, Biology and Physics; Journal Volume: 67; Journal Issue: 1; Other Information: DOI: 10.1016/j.ijrobp.2006.08.038; PII: S0360-3016(06)02795-7; Copyright (c) 2007 Elsevier Science B.V., Amsterdam, Netherlands, All rights reserved; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; BEAMS; CARCINOMAS; FAILURES; HEAD; HISTOLOGY; LINEAR ACCELERATORS; METASTASES; NECK; NECROSIS; PATIENTS; RADIATION DOSES; RADIOTHERAPY; REVIEWS; SURGERY; TOXICITY; WOUNDS

Citation Formats

Chen, Allen M., Bucci, M. Kara, Singer, Mark I., Garcia, Joaquin, Kaplan, Michael J., Chan, Albert S., and Phillips, Theodore L. Intraoperative radiation therapy for recurrent head-and-neck cancer: The UCSF experience. United States: N. p., 2007. Web. doi:10.1016/j.ijrobp.2006.08.038.
Chen, Allen M., Bucci, M. Kara, Singer, Mark I., Garcia, Joaquin, Kaplan, Michael J., Chan, Albert S., & Phillips, Theodore L. Intraoperative radiation therapy for recurrent head-and-neck cancer: The UCSF experience. United States. doi:10.1016/j.ijrobp.2006.08.038.
Chen, Allen M., Bucci, M. Kara, Singer, Mark I., Garcia, Joaquin, Kaplan, Michael J., Chan, Albert S., and Phillips, Theodore L. Mon . "Intraoperative radiation therapy for recurrent head-and-neck cancer: The UCSF experience". United States. doi:10.1016/j.ijrobp.2006.08.038.
@article{osti_20850304,
title = {Intraoperative radiation therapy for recurrent head-and-neck cancer: The UCSF experience},
author = {Chen, Allen M. and Bucci, M. Kara and Singer, Mark I. and Garcia, Joaquin and Kaplan, Michael J. and Chan, Albert S. and Phillips, Theodore L.},
abstractNote = {Purpose: To review a single-institutional experience with the use of intraoperative radiation therapy (IORT) for recurrent head-and-neck cancer. Methods and Materials: Between 1991 and 2004, 137 patients were treated with gross total resection and IORT for recurrence or persistence of locoregional cancer of the head and neck. One hundred and thirteen patients (83%) had previously received external beam radiation as a component of definitive therapy. Ninety-four patients (69%) had squamous cell histology. Final surgical margins were microscopically positive in 56 patients (41%). IORT was delivered using either a modified linear accelerator or a mobile electron unit and was administered as a single fraction to a median dose of 15 Gy (range, 10-18 Gy). Median follow-up among surviving patients was 41 months (range, 3-122 months). Results: The 1-year, 2-year, and 3-year estimates of in-field control after salvage surgery and IORT were 70%, 64%, and 61%, respectively. Positive margins at the time of IORT predicted for in-field failure (p = 0.001). The 3-year rates of locoregional control, distant metastasis-free survival, and overall survival were 51%, 46%, and 36%, respectively. There were no perioperative fatalities. Complications included wound infection (4 patients), orocutaneous fistula (2 patients), flap necrosis (1 patient), trismus (1 patient), and neuropathy (1 patient). Conclusions: Intraoperative RT results in effective disease control with acceptable toxicity and should be considered for selected patients with recurrent or persistent cancers of the head and neck.},
doi = {10.1016/j.ijrobp.2006.08.038},
journal = {International Journal of Radiation Oncology, Biology and Physics},
number = 1,
volume = 67,
place = {United States},
year = {Mon Jan 01 00:00:00 EST 2007},
month = {Mon Jan 01 00:00:00 EST 2007}
}