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
DOI: https://doi.org/10.5114/jcb.2018.78995
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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