High-Dose-Rate Intraoperative Radiation Therapy for Recurrent Head-and-Neck Cancer

Journal Article · Mon Mar 15 00:00:00 EDT 2010 · International Journal of Radiation Oncology, Biology and Physics

DOI:https://doi.org/10.1016/j.ijrobp.2009.03.025· OSTI ID:21372172

Perry, David J; Chan, Kelvin; Wolden, Suzanne; Zelefsky, Michael J ^[1]; Chiu, Johnny; Cohen, Gilad; Zaider, Marco ^[2]; Kraus, Dennis; Shah, Jatin ^[3]; Lee, Nancy ^[1]

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1. Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY (United States)
2. Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, NY (United States)
3. Division of Head and Neck Surgery, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY (United States)

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.

• OSTI ID: 21372172
• Journal Information: International Journal of Radiation Oncology, Biology and Physics, Vol. 76, Issue 4; Other Information: DOI: 10.1016/j.ijrobp.2009.03.025; PII: S0360-3016(09)00460-X; Copyright (c) 2010 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.; ISSN 0360-3016
• Country of Publication: United States
• Language: English

Related Subjects

62 RADIOLOGY AND NUCLEAR MEDICINE
BRACHYTHERAPY
DOSE RATES
HEAD
IRIDIUM 192
NECK
NEOPLASMS
SURVIVAL CURVES
BETA DECAY RADIOISOTOPES
BETA-MINUS DECAY RADIOISOTOPES
BODY
DAYS LIVING RADIOISOTOPES
DISEASES
ELECTRON CAPTURE RADIOISOTOPES
HEAVY NUCLEI
INTERNAL CONVERSION RADIOISOTOPES
IRIDIUM ISOTOPES
ISOMERIC TRANSITION ISOTOPES
ISOTOPES
MEDICINE
MINUTES LIVING RADIOISOTOPES
NUCLEAR MEDICINE
NUCLEI
ODD-ODD NUCLEI
RADIOISOTOPES
RADIOLOGY
RADIOTHERAPY
THERAPY
YEARS LIVING RADIOISOTOPES