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Zhang S, Zeng N, Yang J, He J, Zhu F, Liao W, Xiong M, Li Y. Advancements of radiotherapy for recurrent head and neck cancer in modern era. Radiat Oncol 2023; 18:166. [PMID: 37803477 PMCID: PMC10559506 DOI: 10.1186/s13014-023-02342-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 08/31/2023] [Indexed: 10/08/2023] Open
Abstract
Head and neck cancer is a kind of cancer which can be eradicated from radical radiation therapy. However, with best efforts, nearly 40% patients will experience locoregional recurrence. Locoregional recurrence is the main cause of cancer-related death in head and neck cancers, so local treatments play a key role in improving progression free survival. In the last decades, radiation techniques have been tremendously developed, highly conformal radiation techniques such as intensity-modulated radiotherapy, stereotactic body radiation therapy, brachytherapy and proton or heavy ion radiation therapy have their unique radiobiological advances. Although reirradiation is widely used in clinical practice, but little is known when comparing the different techniques. In this review, we will provide a comprehensive overview of the role of reirradiation in recurrent head and neck cancers including radiation techniques, patient selection, overall clinical benefits, and toxicities.
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Affiliation(s)
- Shu Zhang
- Department of Head and Neck Oncology, Cancer Center, West China Hospital, SCU, Chengdu, Sichuan, China
- Department of Radiation Oncology, Cancer Center, West China Hospital, SCU, Chengdu, Sichuan, China
| | - Ni Zeng
- Department of Head and Neck Oncology, Cancer Center, West China Hospital, SCU, Chengdu, Sichuan, China
| | - Jiangping Yang
- Department of Head and Neck Oncology, Cancer Center, West China Hospital, SCU, Chengdu, Sichuan, China
| | - Jinlan He
- Department of Head and Neck Oncology, Cancer Center, West China Hospital, SCU, Chengdu, Sichuan, China
| | - Fubin Zhu
- Department of Oncology, Chengdu Seventh People's Hospital (Affiliated Cancer Hospital of Chengdu Medical College), Chengdu, China
| | - Wenjun Liao
- Department of Radiation Oncology, Radiation Oncology Key Laboratory of Sichuan Province, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Center, Sichuan Cancer Hospital& Institute, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Maoqi Xiong
- West China Clinical Skills Training Center, West China School of Medicine, West China Hospital, SCU, Chengdu, Sichuan, China
| | - Yan Li
- Department of Radiation Oncology, Cancer Center, West China Hospital, SCU, Chengdu, Sichuan, China.
- Lung Cancer Center, West China Hospital, SCU, Chengdu, Sichuan, China.
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Soror T, Paul J, Melchert C, Idel C, Rades D, Bruchhage KL, Kovács G, Leichtle A. Salvage High-Dose-Rate Interventional Radiotherapy (Brachytherapy) Combined with Surgery for Regionally Relapsed Head and Neck Cancers. Cancers (Basel) 2023; 15:4549. [PMID: 37760518 PMCID: PMC10526533 DOI: 10.3390/cancers15184549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 09/11/2023] [Accepted: 09/11/2023] [Indexed: 09/29/2023] Open
Abstract
(1) Background: to report on the use of high-dose-rate (HDR) interventional radiotherapy (brachytherapy, IRT) as a salvage treatment for patients with regionally relapsed head and neck cancers. (2) Methods: A retrospective study of 60 patients treated with HDR-IRT for loco-regionally relapsed head and neck cancers at our institution (2016-2020). Treatment procedure, results, and related toxicities were collected. Local and overall survival outcomes were analyzed. (3) Results: The median follow-up was 22.4 months. Twenty-nine (48.3%) patients had locoregional recurrences with a median time of 28.9 months. The local-recurrence free-survival was 88.1% and 37.3% at 3 years and 5 years. At the last follow-up, 21 patients were alive and the median time to death was 24 months. The overall survival was 39.2% and 16.6% at 3 years and 5 years. Collectively, there were 28 events of grade ≥ 3 late toxicities recorded in 21 patients (35%). (4) Conclusions: Salvage HDR-IRT combined with surgery offers a second-line curative treatment option for regionally relapsed head and neck cancers with acceptable outcomes and toxicities.
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Affiliation(s)
- Tamer Soror
- Radiation Oncology Department, University of Lübeck/UKSH-CL, 23562 Lübeck, Germany; (C.M.); (D.R.)
- National Cancer Institute (NCI), Radiation Oncology Department, Cairo University, Giza 12613, Egypt
| | - Justina Paul
- Department of Oto-Rhino-Laryngology and Head and Neck Surgery, University of Lübeck, 23562 Lübeck, Germany; (J.P.); (C.I.); (K.-L.B.); (A.L.)
| | - Corinna Melchert
- Radiation Oncology Department, University of Lübeck/UKSH-CL, 23562 Lübeck, Germany; (C.M.); (D.R.)
| | - Christian Idel
- Department of Oto-Rhino-Laryngology and Head and Neck Surgery, University of Lübeck, 23562 Lübeck, Germany; (J.P.); (C.I.); (K.-L.B.); (A.L.)
| | - Dirk Rades
- Radiation Oncology Department, University of Lübeck/UKSH-CL, 23562 Lübeck, Germany; (C.M.); (D.R.)
| | - Karl-Ludwig Bruchhage
- Department of Oto-Rhino-Laryngology and Head and Neck Surgery, University of Lübeck, 23562 Lübeck, Germany; (J.P.); (C.I.); (K.-L.B.); (A.L.)
| | - György Kovács
- Università Cattolica del Sacro Cuore, Gemelli-INTERACTS, 00168 Rome, Italy;
| | - Anke Leichtle
- Department of Oto-Rhino-Laryngology and Head and Neck Surgery, University of Lübeck, 23562 Lübeck, Germany; (J.P.); (C.I.); (K.-L.B.); (A.L.)
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3
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Cheung CK, Chew J, Wai K, Calkins SM, Ha PK, Ryan WR, Cunha A, Yom SS, Hsu IC, Chan JW. Feasibility of accelerated image-guided high-dose-rate interstitial brachytherapy with inverse planning simulated annealing (IPSA-HDRBT) for post-operative treatment of pathologically node-negative squamous cell carcinomas of the oral tongue. Brachytherapy 2022; 21:686-691. [PMID: 35715306 DOI: 10.1016/j.brachy.2022.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 05/16/2022] [Accepted: 05/17/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE Inverse planning simulated annealing (IPSA) produces highly conformal dose distributions and quick optimizations for high-dose-rate interstitial brachytherapy (HDRBT). We report our dosimetry and overall outcomes using this approach for the accelerated post-operative treatment of pathologically node-negative squamous cell carcinomas of the oral tongue (OTSCC) with high risk of local recurrence. METHODS Patients with newly diagnosed pN0 OTSCC treated with partial glossectomy, neck dissection, and post-operative HDRBT alone from 2007 to 2021 were retrospectively reviewed. Patients received 30 Gy in 5 fractions over 2.5 days. Target volume and mandible dosimetry are reported. Actuarial rates of local control, regional control, disease-specific survival, and overall survival were estimated using the Kaplan-Meier method. Toxicity was categorized using the Common Terminology Criteria for Adverse Events (CTCAE) version 5.0. RESULTS 19 consecutive patients were reviewed. Median follow-up was 3.2 years (IQR 1.4-8.2 years) with a 3-year estimated local control rate of 81%. Target volumes were generally small, as the median volume was 12.66 cc. Median V150% and V200% were 52% and 24%, respectively. D1cc and D2cc to the mandible were 17.31 Gy and 14.42 Gy, respectively. CONCLUSIONS IPSA-HDRBT is feasible and highly efficient for post-operative treatment of the primary tumor bed in patients with pathologically node-negative squamous cell carcinomas of the oral tongue. Further technical optimization and prospective clinical evaluation in a larger patient cohort are planned.
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Affiliation(s)
- Christopher K Cheung
- Department of Radiation Oncology, Helen Diller Comprehensive Cancer Care Center, University of California, San Francisco, CA
| | - Jessica Chew
- Department of Radiation Oncology, Helen Diller Comprehensive Cancer Care Center, University of California, San Francisco, CA
| | - Katherine Wai
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, CA
| | - Sarah M Calkins
- Department of Pathology, University of California, San Francisco, CA
| | - Patrick K Ha
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, CA
| | - William R Ryan
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, CA
| | - Adam Cunha
- Department of Radiation Oncology, Helen Diller Comprehensive Cancer Care Center, University of California, San Francisco, CA
| | - Sue S Yom
- Department of Radiation Oncology, Helen Diller Comprehensive Cancer Care Center, University of California, San Francisco, CA
| | - I-Chow Hsu
- Department of Radiation Oncology, Helen Diller Comprehensive Cancer Care Center, University of California, San Francisco, CA
| | - Jason W Chan
- Department of Radiation Oncology, Helen Diller Comprehensive Cancer Care Center, University of California, San Francisco, CA.
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Yamazaki H, Masui K, Suzuki G, Yoshida K, Nakamura S, Isohashi F, Kotsuma T, Takaoka Y, Tanaka E, Akiyama H, Ishibashi N. Reirradiation for recurrent head and neck carcinoma using high-dose-rate brachytherapy: A multi-institutional study. Brachytherapy 2022; 21:341-346. [DOI: 10.1016/j.brachy.2021.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 12/15/2021] [Accepted: 12/28/2021] [Indexed: 11/02/2022]
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Harkenrider MM, Albuquerque K, Brown D, Kamrava M, King M, Mourtada F, Orio P, Patel R, Price M, Rassiah P, Solanki AA, Small W, Schechter NR. ACR-ABS-ASTRO practice parameter for the performance of radionuclide-based high-dose-rate brachytherapy. Brachytherapy 2021; 20:1071-1082. [PMID: 34588143 DOI: 10.1016/j.brachy.2021.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 08/17/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE This practice parameter aims to detail the processes, qualifications of personnel, patient selection, equipment, patient and personnel safety, documentation, and quality control and improvement necessary for an HDR brachytherapy program. METHODS AND MATERIALS This practice parameter was revised collaboratively by the American College of Radiology (ACR), the American Brachytherapy Society (ABS), and the American Society for Radiation Oncology (ASTRO). RESULTS Brachytherapy is a radiotherapeutic modality in which radionuclide or electronic sources are used to deliver a radiation dose at a distance of up to a few centimeters by surface, intracavitary, intraluminal, or interstitial application. Brachytherapy alone or combined with external beam radiotherapy plays an important role in the management and treatment of patients with cancer. High-dose-rate (HDR) brachytherapy uses radionuclides, such as iridium-192, at dose rates of ≥12 Gy/hr to a designated target point or volume, and it is an important treatment for a variety of malignant and benign conditions. Its use allows for application of high doses of radiation to defined target volumes with relative sparing of adjacent critical structures. CONCLUSIONS HDR brachytherapy requires detailed attention to personnel, equipment, patient and personnel safety, and continuing staff education. Coordination between the radiation oncologist and treatment planning staff and effective quality assurance procedures are important components of successful HDR brachytherapy programs.
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Affiliation(s)
| | - Kevin Albuquerque
- UT Southwestern Medical Center, Simmons Comprehensive Cancer Center, Dallas, TX
| | | | | | - Martin King
- Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, MA
| | | | - Peter Orio
- Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, MA
| | | | - Michael Price
- Columbia University Irving Medical Center, New York, NY
| | - Prema Rassiah
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | | | - William Small
- Stritch School of Medicine, Loyola University Chicago, Maywood, IL
| | - Naomi R Schechter
- Keck Medical Center of USC, Norris Comprehensive Cancer, Center, University of Southern California, Los Angeles, CA
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6
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Venkat P, Han J, Demanes DJ. Brachytherapy of the head and neck: An University of California Los Angeles guide to morbidity reduction. Brachytherapy 2021; 20:1014-1040. [PMID: 33487561 DOI: 10.1016/j.brachy.2020.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 11/30/2020] [Accepted: 12/06/2020] [Indexed: 11/16/2022]
Abstract
The head and neck (H&N) region is among the most intricate and functional part of our anatomy. Major functional nerves and blood vessels with importance that affect the entire body emanate from the base of skull. Brachytherapy plays an important role as a single modality therapy in early cancer of the lip and oral cavity and a supplemental role in the pharynx or in advanced or recurrent disease. Morbidity in the H&N is intensely personal and disabling. Its avoidance is critical in determining the success or failure of a treatment program, and it is essential to preservation of quality of life. This article summarizes the current literature regarding morbidity related to H&N brachytherapy to aid patients and physicians to achieve optimal outcomes.
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Affiliation(s)
- Puja Venkat
- Department of Radiation Oncology, University of California Los Angeles, Los Angeles, CA.
| | - James Han
- Department of Radiation Oncology, University of California Los Angeles, Los Angeles, CA
| | - D Jeffrey Demanes
- Department of Radiation Oncology, University of California Los Angeles, Los Angeles, CA
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7
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Biau J, Moreau J, Blanchard P, Thariat J, Miroir J, Lapeyre M. Réirradiations des carcinomes épidermoïdes des voies aérodigestives supérieures : indications et résultats. Cancer Radiother 2019; 23:559-564. [DOI: 10.1016/j.canrad.2019.07.147] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 07/08/2019] [Indexed: 01/12/2023]
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8
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Bussu F, Tagliaferri L, Mattiucci G, Parrilla C, Rizzo D, Gambacorta MA, Lancellotta V, Autorino R, Fonnesu C, Kihlgren C, Galli J, Paludetti G, Kovács G, Valentini V. HDR interventional radiotherapy (brachytherapy) in the treatment of primary and recurrent head and neck malignancies. Head Neck 2019; 41:1667-1675. [DOI: 10.1002/hed.25646] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 10/14/2018] [Accepted: 12/10/2018] [Indexed: 11/09/2022] Open
Affiliation(s)
- Francesco Bussu
- Universitá Cattolica del Sacro CuoreIstituto di Otorinolaringoiatria Roma Italia
- ENT DivisionAzienda Ospedaliero Universitaria Sassari Italia
| | - Luca Tagliaferri
- Fondazione Policlinico Universitario A. Gemelli IRCCSUOC di Radioterapia, Dipartimento di Scienze Radiologiche, Radioterapiche ed Ematologiche Roma Italia
| | - Giancarlo Mattiucci
- Fondazione Policlinico Universitario A. Gemelli IRCCSUOC di Radioterapia, Dipartimento di Scienze Radiologiche, Radioterapiche ed Ematologiche Roma Italia
| | - Claudio Parrilla
- Universitá Cattolica del Sacro CuoreIstituto di Otorinolaringoiatria Roma Italia
| | - Davide Rizzo
- ENT DivisionAzienda Ospedaliero Universitaria Sassari Italia
| | - Maria Antonietta Gambacorta
- Fondazione Policlinico Universitario A. Gemelli IRCCSUOC di Radioterapia, Dipartimento di Scienze Radiologiche, Radioterapiche ed Ematologiche Roma Italia
- Università Cattolica del Sacro CuoreIstituto di Radiologia Roma Italia
| | - Valentina Lancellotta
- Radiation OncologyUniversitá di Perugia, Azienda Ospedaliera di Perugia Perugia Italy
| | - Rosa Autorino
- Fondazione Policlinico Universitario A. Gemelli IRCCSUOC di Radioterapia, Dipartimento di Scienze Radiologiche, Radioterapiche ed Ematologiche Roma Italia
| | - Carla Fonnesu
- ENT DivisionAzienda Ospedaliero Universitaria Sassari Italia
| | | | - Jacopo Galli
- Universitá Cattolica del Sacro CuoreIstituto di Otorinolaringoiatria Roma Italia
| | - Gaetano Paludetti
- Universitá Cattolica del Sacro CuoreIstituto di Otorinolaringoiatria Roma Italia
| | - György Kovács
- Interdisciplinary Brachytherapy UnitUniversity of Lübeck and University Hospital S‐H Campus Lübeck Germany
| | - Vincenzo Valentini
- Fondazione Policlinico Universitario A. Gemelli IRCCSUOC di Radioterapia, Dipartimento di Scienze Radiologiche, Radioterapiche ed Ematologiche Roma Italia
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A systematic review of treating recurrent head and neck cancer: a reintroduction of brachytherapy with or without surgery. J Contemp Brachytherapy 2018; 10:454-462. [PMID: 30479623 PMCID: PMC6251444 DOI: 10.5114/jcb.2018.79399] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 10/21/2018] [Indexed: 11/23/2022] Open
Abstract
Purpose To review brachytherapy use in recurrent head and neck carcinoma (RHNC) with focus on its efficacy and complication rates. Material and methods A literature search of PubMed, Ovid, Google Scholar, and Scopus was conducted from 1990 to 2017. Publications describing treatment of RHNC with brachytherapy with or without surgery were included. The focus of this review is on oncologic outcomes and the safety of brachytherapy in the recurrent setting. Results Thirty studies involving RHNC treatment with brachytherapy were reviewed. Brachytherapy as adjunctive treatment to surgical resection appears to be associated with an improved local regional control and overall survival, when compared with the published rates for re-irradiation utilizing external beam radiotherapy (RT) or brachytherapy alone. Safety data remains variable with different isotopes and dose rates with implantable brachytherapy demonstrating a tolerable side effect profile. Conclusions Although surgery remains a mainstay treatment for RHNC, intraoperative interstitial brachytherapy delivery as adjunctive therapy may improve the treatment outcome and may be associated with fewer complication rates as compared to reirradiation using external beam radiotherapy. Further investigations are required to elucidate the role of brachytherapy for RHNC.
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High-dose-rate interstitial brachytherapy in recurrent head and neck cancer: an effective salvage option. J Contemp Brachytherapy 2018; 10:425-430. [PMID: 30479619 PMCID: PMC6251448 DOI: 10.5114/jcb.2018.78995] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Accepted: 09/04/2018] [Indexed: 02/06/2023] Open
Abstract
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.
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11
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High-dose-rate brachytherapy in severe trismus: Making it happen! J Contemp Brachytherapy 2018; 10:380-384. [PMID: 30237821 PMCID: PMC6142643 DOI: 10.5114/jcb.2018.77958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 08/07/2018] [Indexed: 11/17/2022] Open
Abstract
Brachytherapy has been widely employed as a salvage or adjuvant modality in localized early and/or recurrent lesions. In recent years, advances in brachytherapy techniques have helped to achieve better loco-regional disease control and higher survival rates at the cost of limited morbidity. This is mainly owing to the development of technologically advanced three-dimensional computer planning systems and treatment delivery techniques. Low-dose-rate brachytherapy has been substituted by high-dose-rate and pulsed-dose-rate techniques, which allow better dose optimization. Inter-disciplinary approach results in fabrication of customized intra-oral surface mould, which allows accurate dose delivery, excellent dose distribution, and is less time-consuming. However, fabrication of surface mould becomes extremely challenging when intra-oral anatomic factors are unfavorable. We present a report on the management of a previously-irradiated completely edentulous patient with severe trismus for whom high-dose-rate surface mould brachytherapy had been prescribed. A unique, reliable, and practical solution has been presented based firmly on the scientific knowledge of contemporary implant dentistry.
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12
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Quivrin M, Peignaux-Casasnovas K, Martin É, Rouffiac M, Thibouw D, Chevalier C, Vulquin N, Aubignac L, Truc G, Créhange G. Salvage brachytherapy as a modern reirradiation technique for local cancer failure: The Phoenix is reborn from its ashes. Cancer Radiother 2018; 22:372-381. [DOI: 10.1016/j.canrad.2018.01.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 01/24/2018] [Accepted: 01/30/2018] [Indexed: 01/14/2023]
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13
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Peiffert D, Coche-Dequéant B, Lapeyre M, Renard S. [Brachytherapy for head and neck cancers]. Cancer Radiother 2018; 22:359-366. [PMID: 29858138 DOI: 10.1016/j.canrad.2017.12.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 12/13/2017] [Indexed: 11/25/2022]
Abstract
The main indications of the brachytherapy of head and neck cancers are the limited tumours of the lip, the nose, the oral cavity and the oropharynx. Nasopharynx tumours are nowadays treated by intensity-modulated radiotherapy. This technique can be exclusive, associated with external radiotherapy or postoperative. It can also be a salvage treatment for the second primaries in previously irradiated areas. If the low dose rate brachytherapy rules remain the reference, the pulse dose rate technique allows the prescription of the dose rate and the optimisation of the dose distribution. Results of high dose rate brachytherapy are now published. This paper reports the recommendations of the Gec-ESTRO, published in 2017, and takes into account the data of the historical low dose rate series, and is upgraded with the pulsed-dose rate and high dose rate series.
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Affiliation(s)
- D Peiffert
- Département de radiothérapie, institut de cancérologie de Lorraine Alexis-Vautrin, avenue de Bourgogne, 54511, Vandœuvre-lès-Nancy, France.
| | - B Coche-Dequéant
- Département de radiothérapie, centre Oscar-Lambret, 3, rue Frédéric-Combenale, BP 307, 59020 Lille cedex, France
| | - M Lapeyre
- Département de radiothérapie, centre Jean-Perrin, 58, rue Montalembert, 63011 Clermont-Ferrand cedex 1, France
| | - S Renard
- Département de radiothérapie, institut de cancérologie de Lorraine Alexis-Vautrin, avenue de Bourgogne, 54511, Vandœuvre-lès-Nancy, France
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14
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Ho JC, Phan J. Reirradiation of head and neck cancer using modern highly conformal techniques. Head Neck 2018; 40:2078-2093. [DOI: 10.1002/hed.25180] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Revised: 12/06/2017] [Accepted: 02/20/2018] [Indexed: 12/11/2022] Open
Affiliation(s)
- Jennifer C. Ho
- Department of Radiation Oncology; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Jack Phan
- Department of Radiation Oncology; The University of Texas MD Anderson Cancer Center; Houston Texas
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15
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Hegde JV, Demanes DJ, Veruttipong D, Chin RK, Park SJ, Kamrava M. Head and neck cancer reirradiation with interstitial high-dose-rate brachytherapy. Head Neck 2018; 40:1524-1533. [PMID: 29573121 DOI: 10.1002/hed.25137] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 11/29/2017] [Accepted: 02/01/2018] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND As high-dose-rate (HDR) brachytherapy can preferentially spare normal anatomic structures surrounding the radiation target, we report on our experience using this technique in head and neck cancer reirradiation. METHODS Twenty patients received HDR brachytherapy reirradiation with curative or palliative intent from 2010-2015. Clinical and toxicity outcomes were recorded. Actuarial outcomes were calculated using Kaplan-Meier analysis. RESULTS For curative treatment, actuarial 2-year rates of local control and overall survival (OS) were 73% and 56%, respectively. Palliatively, a 6-month local control rate of 65% was seen. Age >70 years was associated with poorer OS (P = .042). Prior salvage resection showed a trend toward improved local control and OS (P = .069 and P = .063, respectively). Thirty-three percent had grade 3 to 4 late toxicities. CONCLUSION Curative-intent HDR brachytherapy reirradiation can provide excellent local control and encouraging OS. Given the late toxicity rates, patient selection is essential, with particular utility for younger patients or those treated with salvage resection.
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Affiliation(s)
- John V Hegde
- Department of Radiation Oncology, UCLA Medical Center, University of California, Los Angeles, Los Angeles, California
| | - D Jeffrey Demanes
- Department of Radiation Oncology, UCLA Medical Center, University of California, Los Angeles, Los Angeles, California
| | - Darlene Veruttipong
- Department of Radiation Oncology, UCLA Medical Center, University of California, Los Angeles, Los Angeles, California
| | - Robert K Chin
- Department of Radiation Oncology, UCLA Medical Center, University of California, Los Angeles, Los Angeles, California
| | - Sang-June Park
- Department of Radiation Oncology, UCLA Medical Center, University of California, Los Angeles, Los Angeles, California
| | - Mitchell Kamrava
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, California
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Adjuvant high-dose-rate brachytherapy in the management of oral cavity cancers: 5 years of experience in Iran. J Contemp Brachytherapy 2017; 9:323-329. [PMID: 28951751 PMCID: PMC5611461 DOI: 10.5114/jcb.2017.69806] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 07/11/2017] [Indexed: 12/05/2022] Open
Abstract
Purpose Brachytherapy is a cost-effective method for the management of oral cavity cancers in low to middle income countries. We aimed to evaluate the clinical outcomes of high-dose-rate interstitial brachytherapy (HDR-IBT) in patients with oral cavity cancer. Material and methods From 2009 to 2013, 78 patients (49 combined external beam radiotherapy [EBRT] plus IBT and 29 IBT monotherapy) with oral cavity cancers had been treated in our center. Slightly more than half the patients were male, and the median age was 54 years. The treatment was planned based on the Paris system. The main outcomes were disease-free and overall survival. Results The median follow-up duration was 36.5 months (range, 1.17-54.23). The actuarial four-year overall and disease-free survival rates were 83% and 65%, respectively. The local and locoregional control was achieved among 89.74% and 87.17% of patients, respectively. None of the factors including tumor size, node status, gender, and radiation modality (IBT alone vs. IBT + EBRT) had a significant statistical correlation to the local control rate. All the patients tolerated the planned treatment in the IBT alone group. Late complications included a case of trismus and three cases of catheter insertion site fibrosis. Conclusions HDR-IBT as a monotherapy or in combination with EBRT is an appropriate option for the management of oral cavity squamous cell carcinomas, and supports the improvement in treatment outcomes and toxicity profiles in adjuvant settings.
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Erickson BA, Bittner NHJ, Chadha M, Mourtada F, Demanes DJ. The American College of Radiology and the American Brachytherapy Society practice parameter for the performance of radionuclide-based high-dose-rate brachytherapy. Brachytherapy 2017; 16:75-84. [PMID: 28109634 DOI: 10.1016/j.brachy.2016.05.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 05/17/2016] [Indexed: 11/16/2022]
Abstract
Brachytherapy is a radiation therapy method in which radionuclide sources are used to deliver a radiation dose at a distance of up to a few centimeters by surface, intracavitary, intraluminal, or interstitial application. This practice parameter refers only to the use of radionuclides for brachytherapy. Brachytherapy alone or combined with external beam therapy plays an important role in the management and treatment of patients with cancer. High-dose-rate (HDR) brachytherapy uses radionuclides such as iridium-192 at dose rates of 20 cGy per minute (12 Gy per hour) or more to a designated target point or volume. High-dose-rate (HDR) brachytherapy is indicated for treating malignant or benign tumors where the treatment volume or targeted points are defined and accessible.
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Affiliation(s)
| | | | | | - Firas Mourtada
- Helen F. Graham Cancer Center & Research Institute, Christiana Care Health System, Newark, DE, USA
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Patel RA, Lock D, Kim T, Samant S, Chandler JP, Mittal BB, Kruser TJ. Single Fraction Stereotactic Radiosurgery for Retreatment of Skull Base Recurrent Head and Neck Malignancies. Cureus 2017; 9:e1206. [PMID: 28580203 PMCID: PMC5451202 DOI: 10.7759/cureus.1206] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Recurrent head and neck carcinomas are notoriously difficult to treat. Salvage surgery, brachytherapy, and repeat external beam radiotherapy have all been utilized, achieving modest local control at the expense of elevated toxicity. We performed a retrospective review to evaluate the efficacy of single fraction stereotactic radiosurgery (SRS) for the treatment of recurrent head and neck carcinomas. METHODS Eighteen previously irradiated patients diagnosed with a locoregionally recurrent head and neck malignancy and treated with single fraction SRS from 2000 to 2016 were analyzed. Actuarial rates for local control (LC) and overall survival (OS) were calculated with Kaplan-Meier estimates. RESULTS Median follow-up was 16.1 months and SRS dose was 13.3 Gy. One-year rate of LC was 52.7% (95% confidence interval [CI] 29%-72%). Median OS was 25.4 months. Parotid gland primary had an increased risk of progressive disease (PD) following SRS (hazard ratio [HR] 4.24, p=0.02). Squamous cell histology was negatively associated with OS (HR 3.85, p=0.03). One patient experienced grade 2 radionecrosis. CONCLUSIONS Single fraction SRS is an acceptable treatment for previously irradiated patients with recurrent head and neck primary malignancies. Dose escalation to optimize LC should be examined.
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Affiliation(s)
- Rajal A Patel
- Department of Radiation Oncology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Derrick Lock
- Chicago Medical School, Rosalind Franklin University of Medicine and Science
| | - Thomas Kim
- Department of Radiation Oncology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Sandeep Samant
- Department of Otolaryngology Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - James P Chandler
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Bharat B Mittal
- Department of Radiation Oncology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Tim J Kruser
- Department of Radiation Oncology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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19
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Tselis N, Karagiannis E, Kolotas C, Baghi M, Milickovic N, Zamboglou N. Image-guided interstitial high-dose-rate brachytherapy in the treatment of inoperable recurrent head and neck malignancies: An effective option of reirradiation. Head Neck 2017; 39:E61-E68. [DOI: 10.1002/hed.24697] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2016] [Revised: 11/06/2016] [Accepted: 12/06/2016] [Indexed: 12/12/2022] Open
Affiliation(s)
- Nikolaos Tselis
- Department of Radiotherapy and Oncology; J. W. Goethe University; Frankfurt am Main Germany
| | | | - Christos Kolotas
- Institute for Radiotherapy; Hirslanden Medical Center; Aarau Switzerland
| | - Mehran Baghi
- Department of Otorhinolaryngology; J. W. Goethe University; Frankfurt am Main Germany
| | - Natasa Milickovic
- Department of Medical Physics and Engineering; Sana Klinikum Offenbach; Offenbach am Main Germany
| | - Nikolaos Zamboglou
- Department of Radiotherapy and Oncology; J. W. Goethe University; Frankfurt am Main Germany
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20
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Neither high-dose nor low-dose brachytherapy increases flap morbidity in salvage treatment of recurrent head and neck cancer. J Contemp Brachytherapy 2016; 8:308-12. [PMID: 27648084 PMCID: PMC5018532 DOI: 10.5114/jcb.2016.61976] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2016] [Accepted: 08/10/2016] [Indexed: 11/24/2022] Open
Abstract
Purpose While brachytherapy is often used concurrently with flap reconstruction following surgical ablation for head and neck cancer, it remains unclear whether it increases morbidity in the particularly high risk subset of patients undergoing salvage treatment for recurrent head and neck cancer (RH&NC). Material and methods A retrospective chart review was undertaken that evaluated patients with RH&NC who underwent flap coverage after surgical re-resection and concomitant brachytherapy. The primary endpoint was flap viability, and the secondary endpoints were flap and recipient site complications. Results In the 23 subjects included in series, flap viability and skin graft take was 100%. Overall recipient site complication rate was 34.8%, high-dose radiation (HDR) group 50%, and low-dose radiation (LDR) group 29.4%. There was no statistically significant difference between these groups. Conclusions In patients who undergo flap reconstruction and immediate postoperative radiotherapy following salvage procedures for RH&NC, flap coverage of defects in combination with brachytherapy remains a safe and effective means of providing stable soft tissue coverage.
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21
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Hazkani I, Rabinovics N, Limon D, Silvern D, Koren S, Hadar T, Bachar G, Shpitzer T, Popovtzer A. Brachytherapy for radiotherapy-resistant head and neck cancer: A review of a single center experience. Laryngoscope 2016; 126:2246-51. [PMID: 26928864 DOI: 10.1002/lary.25938] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 01/26/2016] [Accepted: 01/29/2016] [Indexed: 11/09/2022]
Abstract
OBJECTIVES/HYPOTHESIS Despite advances in radiotherapy and chemotherapy treatments for head and neck cancers, the local failure rate is high. In most radiotherapy-resistant cases, surgery is performed; however, some cases are considered unresectable. No standard treatment for these situations has been established. In this study, we review our experience with brachytherapy (BT), which has a different biological mechanism than standard radiotherapy. METHODS All patients received prior radiation to the recurrence area. Median high-dose radiation BT dose was 50 Gy, administered in 5 to 10 Gy fractions twice daily for 5 days. High-dose radiation was given via four to 10 catheters inserted under local anesthesia (3 patients) or general anesthesia with preventive tracheostomy (10 patients). RESULTS Thirteen patients received BT from 2010 to 2014. Male:female ratio was 1.6:1, and median age was 66 years (range 23-89). Of those 13 patients, 10 patients were diagnosed with squamous cell carcinoma (SCC) of the oral cavity, two patients with SCC of the nasal mucosa, and one patient with eccrine duct carcinoma. Prior radiation dose ranged from 60 to 70 Gy. Local control was achieved in 11 of 13 patients; only 15.3% (2 of 13) had in-field recurrence. Five patients developed local out-of-field recurrence, and two developed distant metastases. Five patients are alive with no evidence of disease. No major toxicities were encountered. Two patients had severe mucositis and recovered within several weeks. CONCLUSION Brachytherapy for radiotherapy-resistant head and neck cancers is feasible with minor adverse events, which enables good local control. However, many advanced head and neck cancers develop regional or distant metastases; therefore, additional treatment should be suggested. LEVEL OF EVIDENCE 4. Laryngoscope, 126:2246-2251, 2016.
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Affiliation(s)
- Inbal Hazkani
- Department of Otorhinolaryngology Head and Neck Surgery, Meir Medical Center, Kfar Saba, Israel.
| | - Naomi Rabinovics
- Department of Otorhinolaryngology Head and Neck Surgery, Davidoff Center, Rabin Medical Center, Petach Tikva, Israel and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dror Limon
- Department of Oncology, Davidoff Center, Rabin Medical Center, Petach Tikva, Israel and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - David Silvern
- Department of Oncology, Davidoff Center, Rabin Medical Center, Petach Tikva, Israel and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sion Koren
- Department of Oncology, Davidoff Center, Rabin Medical Center, Petach Tikva, Israel and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tuvia Hadar
- Department of Otorhinolaryngology Head and Neck Surgery, Davidoff Center, Rabin Medical Center, Petach Tikva, Israel and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gideon Bachar
- Department of Otorhinolaryngology Head and Neck Surgery, Davidoff Center, Rabin Medical Center, Petach Tikva, Israel and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Thomas Shpitzer
- Department of Otorhinolaryngology Head and Neck Surgery, Davidoff Center, Rabin Medical Center, Petach Tikva, Israel and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Aron Popovtzer
- Department of Oncology, Davidoff Center, Rabin Medical Center, Petach Tikva, Israel and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Ritter M, Teudt IU, Meyer JE, Schröder U, Kovács G, Wollenberg B. Second-line treatment of recurrent HNSCC: tumor debulking in combination with high-dose-rate brachytherapy and a simultaneous cetuximab-paclitaxel protocol. Radiat Oncol 2016; 11:6. [PMID: 26792072 PMCID: PMC4719334 DOI: 10.1186/s13014-016-0583-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2015] [Accepted: 01/01/2016] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND AND PURPOSE After the failure of first-line treatment, the clinical prognosis in head and neck cancer (HNSCC) deteriorates. Effective therapeutic strategies are limited due to the toxicity of previous treatments and the diminished tolerance of surrounding normal tissue. This study demonstrates a promising second-line regimen, with function preserving surgical tumor debulking, followed by a combination of postoperative interstitial brachytherapy and a simultaneous protocol of cetuximab and taxol. PATIENTS AND METHODS From January 2006 to May 2013, 197 patients with HNSCC were treated with brachytherapy at the University Hospital Schleswig-Holstein Campus Lübeck, including 94 patients due to recurrent cancer. Within these, 18 patients were referred to our clinic because of early progressive disease following first- or second-line treatment failure. They received the new palliative regimen. A matched-pair analysis including recurrent tumor stage, status of resection margins, tissue invasion and previous therapy was performed to evaluate this treatment retrospectively. Overall survival (OS), disease-free survival (DFS), functional outcome and treatment toxicity was analyzed on the basis of medical records and follow-up data. RESULTS DFS and OS of the study group were 8.7 and 14.8 months. Whereas, DFS and OS of the control group, treated only by function preserving tumor debulking and brachytherapy, was 3.9 and 6.1 months respectively. This demonstrates a positive trend through the additional use of the cetuximab-taxane protocol. Furthermore, no increase of therapy induced toxicities was displayed. CONCLUSION Pre-treated patients with a further relapse benefit from the 'cetuximab-taxane recurrency scheme'. It seems to be a valuable complement to interdisciplinary and multimodal tumor therapy, which improves OS and results in acceptable toxicity.
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Affiliation(s)
- M Ritter
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Schleswig-Holstein Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany.
| | - I U Teudt
- Department of Otorhinolaryngology, Head and Neck Surgery, Asklepios Hospital Altona, Paul-Ehrlich-Straße 1, 22763, Hamburg, Germany.
| | - J E Meyer
- Department of Otorhinolaryngology, Head and Neck Surgery, Asklepios Hospital St.Georg, Lohmühlenstraße 5, 20099, Hamburg, Germany.
| | - U Schröder
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Schleswig-Holstein Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany.
| | - G Kovács
- Interdisziplinary Brachytherapy Unit, University Hospital Schleswig-Holstein Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany.
| | - B Wollenberg
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Schleswig-Holstein Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany.
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Head and Neck Brachytherapy: A Description of Methods and a Summary of Results. Brachytherapy 2016. [DOI: 10.1007/978-3-319-26791-3_7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Cesium-131 brachytherapy in high risk and recurrent head and neck cancers: first report of long-term outcomes. J Contemp Brachytherapy 2015; 7:445-52. [PMID: 26816501 PMCID: PMC4716131 DOI: 10.5114/jcb.2015.56764] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 11/14/2015] [Indexed: 01/29/2023] Open
Abstract
Purpose The feasibility and efficacy of re-irradiation using contemporary radiation techniques to treat recurrent head and neck cancer has been demonstrated but the role of brachytherapy is unclear. Here we describe the use of 131Cs brachytherapy with concurrent salvage surgery in 18 patients. Material and methods Eligible patients underwent maximal gross resection of the tumor with implantation of brachytherapy seeds delivering a minimum dose of 80 Gy to the tumor bed. Rates of overall survival, locoregional progression free survival, disease-free survival, and radiation-induced toxicity were analyzed. Results Retrospective Kaplan-Meier analysis shows median overall survival was 15 months and disease free survival was 12 months. Two patients developed grade 3 toxicity; all other complications were grade 1-2 with no grade 4 or 5 complications. Conclusions Compared to prior literature, our study shows comparable rates of survival with a decreased rate of radiation-induced toxicity.
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25
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Image-guided high-dose-rate brachytherapy: preliminary outcomes and toxicity of a joint interventional radiology and radiation oncology technique for achieving local control in challenging cases. J Contemp Brachytherapy 2015; 7:327-35. [PMID: 26622237 PMCID: PMC4663208 DOI: 10.5114/jcb.2015.54947] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Accepted: 10/03/2015] [Indexed: 12/16/2022] Open
Abstract
PURPOSE To determine the ability of image-guided high-dose-rate brachytherapy (IG-HDR) to provide local control (LC) of lesions in non-traditional locations for patients with heavily pre-treated malignancies. MATERIAL AND METHODS This retrospective series included 18 patients treated between 2012 and 2014 with IG-HDR, either in combination with external beam radiotherapy (EBRT; n = 9) or as monotherapy (n = 9). Lesions were located in the pelvis (n = 5), extremity (n = 2), abdomen/retroperitoneum (n = 9), and head/neck (n = 2). All cases were performed in conjunction between interventional radiology and radiation oncology. Toxicity was graded based on CTCAE v4.0 and local failure was determined by RECIST criteria. Kaplan-Meier analysis was performed for LC and overall survival. RESULTS The median follow-up was 11.9 months. Two patients had localized disease at presentation; the remainder had recurrent and/or metastatic disease. Seven patients had prior EBRT, with a median equivalent dose in 2 Gy fractions (EQD2) of 47.0 Gy. The median total EQD2s were 34 Gy and 60.9 Gy for patients treated with monotherapy or combination therapy, respectively. Image-guided high-dose rate brachytherapy was delivered in one to six fractions. Six patients had local failures at a median interval of 5.27 months with a one-year LC rate of 59.3% and a one-year overall survival of 40.7%. Six patients died from their disease at a median interval of 6.85 months from the end of treatment. There were no grade ≥ 3 acute toxicities but two patients had serious long term toxicities. CONCLUSIONS We demonstrate a good one year LC rate of nearly 60%, and a favorable toxicity profile when utilizing IG-HDR to deliver high doses of radiation with high precision into targets not readily accessible by other forms of local therapy. These preliminary results suggest that further studies utilizing this approach may be considered for patients with difficult to access lesions that require LC.
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Hyperfractionated stereotactic reirradiation for recurrent head and neck cancer. Strahlenther Onkol 2015; 192:40-6. [PMID: 26314584 DOI: 10.1007/s00066-015-0886-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 07/31/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE The goal of this work was to evaluate the efficacy and toxicity of hyperfractionated stereotactic reirradiation (re-RT) as a treatment for inoperable, recurrent, or second primary head and neck squamous cell cancer (HNSCC) that is not suitable for systemic treatment. PATIENTS AND MATERIALS Forty patients with recurrent or second primary HNSCC were included in this study. The patients had a median gross tumor volume of 76 ml (range 14-193 ml) and a previous radiotherapy dose greater than 60 Gy. Treatment was designed to cover 95 % of the planning target volume (PTV, defined as gross tumor volume [GTV] + 3 mm to account for microscopic spreading, with no additional set-up margin) with the prescribed dose (48 Gy in 16 fractions b.i.d.). Treatment was administered twice daily with a minimum 6 h gap. Uninvolved lymph nodes were not irradiated. RESULTS Treatment was completed as planned for all patients (with median duration of 11 days, range 9-14 days). Acute toxicity was evaluated using the RTOG/EORTC scale. A 37 % incidence of grade 3 mucositis was observed, with recovery time of ≤ 4 weeks for all of these patients. Acute skin toxicity was never observed to be higher than grade 2. Late toxicity was also evaluated according to the RTOG/EORTC scale. Mandible radionecrosis was seen in 4 cases (10 %); however, neither carotid blowout syndrome nor other grade 4 late toxicity occurred. One-year overall survival (OS) and local progression-free survival (L-PFS) were found to be 33 and 44 %, respectively. Performance status and GTV proved to be significant prognostic factors regarding local control and survival. CONCLUSION Hyperfractionated stereotactic re-RT is a reasonable treatment option for patients with recurrent/second primary HNSCC who were previously exposed to high-dose irradiation and who are not candidates for systemic treatment or hypofractionation.
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Tagliaferri L, Bussu F, Rigante M, Gambacorta MA, Autorino R, Mattiucci GC, Fionda B, Miccichè F, Placidi E, Balducci M, Galli J, Valentini V, Paludetti G, Kovacs G. Endoscopy-guided brachytherapy for sinonasal and nasopharyngeal recurrences. Brachytherapy 2015; 14:419-25. [PMID: 25620162 DOI: 10.1016/j.brachy.2014.11.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Revised: 11/20/2014] [Accepted: 11/25/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVE/PURPOSE To evaluate the preliminary results of perioperative endoscopy-guided brachytherapy (BT) in recurrent sinonasal and nasopharyngeal tumors already treated for their primary tumor with a full course of radiotherapy. METHODS AND MATERIALS Patients with recurrence and already treated with a previous full course of radiotherapy >65 Gy who underwent BT from December 2010 to January 2014 were taken into account for this work. Macroscopic disease was resected by an endoscopic approach, and catheters for BT were endoscopically positioned and fixed at the same time on the surgical bed. Surgery was performed under electromagnetic navigation guidance. The irradiation dose was 30 Gy in 12 fractions, 2.5 Gy each, twice a day, in 6 days. RESULTS We performed the endoscopy-guided BT 11 times in 9 patients; in two cases, no previous radiation therapy had been performed; and in one case, followup was too short to be considered. A total of 6 patients were eligible for the analysis. One patient underwent BT three times because of previous target margin recurrences. There were no immediate complications. The median and mean followups were 21 and 19 months, respectively. The median V90 and V85% were 93% and 95%, respectively. In one case, we had a transient deficit of the VI cranial nerve (G3), and in another case, we diagnosed a noncomplicated osteonecrosis (G2). The median disease-free survival is 12 months, and the median overall survival is 23 months. CONCLUSIONS The combination of endoscopy and BT seems to be a safe option for treating recurrent sinonasal and nasopharyngeal tumors.
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Affiliation(s)
- Luca Tagliaferri
- Department of Radiation Oncology, Catholic University, Rome, Italy
| | - Francesco Bussu
- Department of Otorhinolaringoiatry, Catholic University, Rome, Italy.
| | - Mario Rigante
- Department of Otorhinolaringoiatry, Catholic University, Rome, Italy
| | | | - Rosa Autorino
- Department of Radiation Oncology, Catholic University, Rome, Italy
| | | | - Bruno Fionda
- Department of Radiation Oncology, Catholic University, Rome, Italy
| | | | | | - Mario Balducci
- Department of Radiation Oncology, Catholic University, Rome, Italy
| | - Jacopo Galli
- Department of Otorhinolaringoiatry, Catholic University, Rome, Italy
| | | | - Gaetano Paludetti
- Department of Otorhinolaringoiatry, Catholic University, Rome, Italy
| | - Gyoergy Kovacs
- Interdisciplinary Brachytherapy Unit, University of Lübeck & University Hospital S-H, Campus Lübeck, Germany
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28
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Strnad V, Lotter M, Kreppner S, Fietkau R. Reirradiation for recurrent head and neck cancer with salvage interstitial pulsed-dose-rate brachytherapy. Strahlenther Onkol 2015; 191:495-500. [DOI: 10.1007/s00066-014-0809-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Accepted: 12/19/2014] [Indexed: 01/13/2023]
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29
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Lee SU, Cho KH, Moon SH, Choi SW, Park JY, Yun T, Lee SH, Lim YK, Jeong CY. Clinical outcome of high-dose-rate interstitial brachytherapy in patients with oral cavity cancer. Radiat Oncol J 2015; 32:238-46. [PMID: 25568852 PMCID: PMC4282998 DOI: 10.3857/roj.2014.32.4.238] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Revised: 11/19/2014] [Accepted: 12/08/2014] [Indexed: 11/04/2022] Open
Abstract
Purpose To evaluate the clinical outcome of high-dose-rate (HDR) interstitial brachytherapy (IBT) in patients with oral cavity cancer. Materials and Methods Sixteen patients with oral cavity cancer treated with HDR remote-control afterloading brachytherapy using 192Ir between 2001 and 2013 were analyzed retrospectively. Brachytherapy was administered in 11 patients as the primary treatment and in five patients as salvage treatment for recurrence after the initial surgery. In 12 patients, external beam radiotherapy (50-55 Gy/25 fractions) was combined with IBT of 21 Gy/7 fractions. In addition, IBT was administered as the sole treatment in three patients with a total dose of 50 Gy/10 fractions and as postoperative adjuvant treatment in one patient with a total of 35 Gy/7 fractions. Results The 5-year overall survival of the entire group was 70%. The actuarial local control rate after 3 years was 84%. All five recurrent cases after initial surgery were successfully salvaged using IBT ± external beam radiotherapy. Two patients developed local recurrence at 3 and 5 months, respectively, after IBT. The acute complications were acceptable (≤grade 2). Three patients developed major late complications, such as radio-osteonecrosis, in which one patient was treated by conservative therapy and two required surgical intervention. Conclusion HDR IBT for oral cavity cancer was effective and acceptable in diverse clinical settings, such as in the cases of primary or salvage treatment.
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Affiliation(s)
- Sung Uk Lee
- Proton Therapy Center, National Cancer Center, Goyang, Korea
| | - Kwan Ho Cho
- Proton Therapy Center, National Cancer Center, Goyang, Korea. ; Center for Specific Organs Cancer, National Cancer Center, Goyang, Korea
| | - Sung Ho Moon
- Proton Therapy Center, National Cancer Center, Goyang, Korea. ; Center for Specific Organs Cancer, National Cancer Center, Goyang, Korea
| | - Sung Weon Choi
- Center for Specific Organs Cancer, National Cancer Center, Goyang, Korea
| | - Joo Yong Park
- Center for Specific Organs Cancer, National Cancer Center, Goyang, Korea
| | - Tak Yun
- Center for Specific Organs Cancer, National Cancer Center, Goyang, Korea
| | - Sang Hyun Lee
- Center for Specific Organs Cancer, National Cancer Center, Goyang, Korea
| | - Young Kyung Lim
- Proton Therapy Center, National Cancer Center, Goyang, Korea
| | - Chi Young Jeong
- Proton Therapy Center, National Cancer Center, Goyang, Korea
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Kovács G. Modern head and neck brachytherapy: from radium towards intensity modulated interventional brachytherapy. J Contemp Brachytherapy 2015; 6:404-16. [PMID: 25834586 PMCID: PMC4300360 DOI: 10.5114/jcb.2014.47813] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Revised: 10/29/2014] [Accepted: 11/27/2014] [Indexed: 11/17/2022] Open
Abstract
Intensity modulated brachytherapy (IMBT) is a modern development of classical interventional radiation therapy (brachytherapy), which allows the application of a high radiation dose sparing severe adverse events, thereby further improving the treatment outcome. Classical indications in head and neck (H&N) cancers are the face, the oral cavity, the naso- and oropharynx, the paranasal sinuses including base of skull, incomplete resections on important structures, and palliation. The application type can be curative, adjuvant or perioperative, as a boost to external beam radiation as well as without external beam radiation and with palliative intention. Due to the frequently used perioperative application method (intraoperative implantation of inactive applicators and postoperative performance of radiation), close interdisciplinary cooperation between surgical specialists (ENT-, dento-maxillary-facial-, neuro- and orbital surgeons), as well interventional radiotherapy (brachytherapy) experts are obligatory. Published results encourage the integration of IMBT into H&N therapy, thereby improving the prognosis and quality of life of patients.
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Affiliation(s)
- György Kovács
- Interdisciplinary Brachytherapy Unit, University of Lübeck/University Hospital Schleswig-Holstein Campus Lübeck, Germany
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Reirradiation for patients with recurrence head and neck squamous cell carcinoma: a single-institution comparative study. MEDICINA-LITHUANIA 2014; 50:92-9. [PMID: 25172603 DOI: 10.1016/j.medici.2014.06.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Accepted: 03/27/2014] [Indexed: 11/21/2022]
Abstract
BACKGROUND AND OBJECTIVE In the last decade, the number of publications that report on the use of external beam radiotherapy and high-dose-rate brachytherapy (HDR-BRT) in the treatment of recurrent head and neck cancer has increased, but no studies compare external beam radiotherapy and HDR-BRT. The aim of this study was to evaluate and to compare the efficacy and toxicity of the three-dimensional conformal radiotherapy (3D-CRT) and HDR-BRT in the treatment of recurrent head and neck cancer. MATERIAL AND METHODS A total of 64 patients with head and neck cancer recurrence were randomly assigned at a 1:1 ratio to receive either 3D-CRT (50Gy/25 fractions) in the control group or HDR-BRT (30Gy/12 fraction) in the experimental group. RESULTS The overall survival rate of patients treated with HDR-BRT at 1 and 2-years was 74% and 67%, respectively, compare to 3D-CRT group - 51% and 32%, respectively (P=0.002). Local control at 1- and 2-years in patients who received HDR-BRT was 77% and 63% compare with 47% and 25%, respectively, for the patients who received the 3D-CRT (P<0.001). Most patients developed mild to moderate acute mucositis and dermatitis. In the 3D-CRT group, severe late toxicity was determined in 11 patients (35.5%), and in the HDR-BRT group, in 1 patient (3.1%) (P=0.001). There was no grade 5 toxicity. CONCLUSIONS Following our results, we concluded that HDR-BRT is a more effective and safer treatment approach for head and neck cancer recurrences than 3D-CRT.
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Strnad V, Lotter M, Kreppner S, Fietkau R. Re-irradiation with interstitial pulsed-dose-rate brachytherapy for unresectable recurrent head and neck carcinoma. Brachytherapy 2014; 13:187-95. [DOI: 10.1016/j.brachy.2013.10.008] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Revised: 08/26/2013] [Accepted: 10/16/2013] [Indexed: 01/07/2023]
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The role of re-irradiation of secondary and recurrent head and neck carcinomas. Is it a potentially curative treatment? A practical approach. Cancer Treat Rev 2013; 40:178-89. [PMID: 23993769 DOI: 10.1016/j.ctrv.2013.08.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Revised: 05/18/2013] [Accepted: 08/01/2013] [Indexed: 11/22/2022]
Abstract
Despite aggressive efforts to cure head and neck cancer patients, including altered fractionation and the addition of chemotherapy to radiation, locoregional recurrence remains a serious issue to face in clinical practice. Indeed, recurrent and second primary tumors occurring in previously irradiated area are common clinical challenge. Whenever possible, patients are advised to undergo salvage surgery. Nevertheless, few patients are suitable candidates for curative resection. In such cases, chemotherapy alone has traditionally been considered, with a poor response rate. It has been questioned whether re-irradiation toxicity outweighs the potential benefits, considering that the median survival of re-irradiated patients marginally exceeds the benefits observed with chemotherapy alone. However, full-dose re-irradiation is a viable treatment option, offering long-term survival for selected patients. Moreover, several prognostic factors should be considered for patients undergoing re-irradiation, such as basic patient characteristics, performance status, the location and extension of recurrent disease, patient co-morbidities, current speech and swallowing function, the interval from the initial radiation therapy to recurrence, previously received doses by critical structures and prior treatment toxicity. Nevertheless, several questions remain unanswered. The purpose of this review is to evaluate the major issues in the field of re-irradiation regarding the current evidence. Therefore, the major selection criteria and new treatment strategies are discussed to define the ideal candidates to undergo re-irradiation and describe a practical approach to these patients. Given the limited evidence in this field, the optimal treatment of recurrent and second primary cancers remains to be defined. Future prospective study of this approach is warranted.
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Curiethérapie des cancers des voies aérodigestives supérieures. Cancer Radiother 2013; 17:130-5. [DOI: 10.1016/j.canrad.2013.01.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Accepted: 01/21/2013] [Indexed: 11/16/2022]
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Yamazaki H, Yoshida K, Yoshioka Y, Shimizutani K, Furukawa S, Koizumi M, Ogawa K. High dose rate brachytherapy for oral cancer. JOURNAL OF RADIATION RESEARCH 2013; 54:1-17. [PMID: 23179377 PMCID: PMC3534285 DOI: 10.1093/jrr/rrs103] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2012] [Revised: 09/26/2012] [Accepted: 10/09/2012] [Indexed: 05/25/2023]
Abstract
Brachytherapy results in better dose distribution compared with other treatments because of steep dose reduction in the surrounding normal tissues. Excellent local control rates and acceptable side effects have been demonstrated with brachytherapy as a sole treatment modality, a postoperative method, and a method of reirradiation. Low-dose-rate (LDR) brachytherapy has been employed worldwide for its superior outcome. With the advent of technology, high-dose-rate (HDR) brachytherapy has enabled health care providers to avoid radiation exposure. This therapy has been used for treating many types of cancer such as gynecological cancer, breast cancer, and prostate cancer. However, LDR and pulsed-dose-rate interstitial brachytherapies have been mainstays for head and neck cancer. HDR brachytherapy has not become widely used in the radiotherapy community for treating head and neck cancer because of lack of experience and biological concerns. On the other hand, because HDR brachytherapy is less time-consuming, treatment can occasionally be administered on an outpatient basis. For the convenience and safety of patients and medical staff, HDR brachytherapy should be explored. To enhance the role of this therapy in treatment of head and neck lesions, we have reviewed its outcomes with oral cancer, including Phase I/II to Phase III studies, evaluating this technique in terms of safety and efficacy. In particular, our studies have shown that superficial tumors can be treated using a non-invasive mold technique on an outpatient basis without adverse reactions. The next generation of image-guided brachytherapy using HDR has been discussed. In conclusion, although concrete evidence is yet to be produced with a sophisticated study in a reproducible manner, HDR brachytherapy remains an important option for treatment of oral cancer.
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Affiliation(s)
- Hideya Yamazaki
- Department of Radiology, Kyoto Prefectural University of Medicine, 465 Kajiicho Kawaramachi Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan.
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High-dose-rate and pulsed-dose-rate brachytherapy in palliative treatment of head and neck cancers. Brachytherapy 2012; 11:137-43. [DOI: 10.1016/j.brachy.2011.09.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2011] [Revised: 08/15/2011] [Accepted: 09/05/2011] [Indexed: 11/24/2022]
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Yamazaki H, Kodani N, Ogita M, Sato K, Himei K. Reirradiation of head and neck cancer focusing on hypofractionated stereotactic body radiation therapy. Radiat Oncol 2011; 6:98. [PMID: 21854640 PMCID: PMC3179722 DOI: 10.1186/1748-717x-6-98] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2011] [Accepted: 08/21/2011] [Indexed: 11/10/2022] Open
Abstract
Reirradiation is a feasible option for patients who do not otherwise have treatment options available. Depending on the location and extent of the tumor, reirradiation may be accomplished with external beam radiotherapy, brachytherapy, radiosurgery, or intensity modulated radiation therapy (IMRT). Although there has been limited experience with hypofractionated stereotactic radiotherapy (hSRT), it may have the potential for curative or palliative treatment due to its advanced precision technology, particularly for limited small lesion. On the other hand, severe late adverse reactions are anticipated with reirradiation than with initial radiation therapy. The risk of severe late complications has been reported to be 20- 40% and is related to prior radiotherapy dose, primary site, retreatment radiotherapy dose, treatment volume, and technique. Early researchers have observed lethal bleeding in such patients up to a rate of 14%. Recently, similar rate of 10-15% was observed for fatal bleeding with use of modern hSRT like in case of carotid blowout syndrome. To determine the feasibility and efficacy of reirradiation using modern technology, we reviewed the pertinent literature. The potentially lethal side effects should be kept in mind when reirradiation by hSRT is considered for treatment, and efforts should be made to minimize the risk in any future investigations.
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Affiliation(s)
- Hideya Yamazaki
- Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto, Japan.
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Erickson BA, Demanes DJ, Ibbott GS, Hayes JK, Hsu ICJ, Morris DE, Rabinovitch RA, Tward JD, Rosenthal SA. American Society for Radiation Oncology (ASTRO) and American College of Radiology (ACR) Practice Guideline for the Performance of High-Dose-Rate Brachytherapy. Int J Radiat Oncol Biol Phys 2011; 79:641-9. [DOI: 10.1016/j.ijrobp.2010.08.046] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2010] [Accepted: 08/30/2010] [Indexed: 10/18/2022]
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Tselis N, Ratka M, Vogt HG, Kolotas C, Baghi M, Baltas D, Fountzilas G, Georgoulias V, Ackermann H, Zamboglou N. Hypofractionated accelerated CT-guided interstitial 192Ir-HDR-Brachytherapy as re-irradiation in inoperable recurrent cervical lymphadenopathy from head and neck cancer. Radiother Oncol 2011; 98:57-62. [DOI: 10.1016/j.radonc.2010.10.025] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2009] [Revised: 02/02/2010] [Accepted: 10/28/2010] [Indexed: 11/17/2022]
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Chakrabarti B, Ghorai S, Basu B, Ghosh SK, Gupta P, Ghosh K, Ghosh P. Late nodal metastasis in early-stage node-negative oral cavity cancers after successful sole interstitial brachytherapy: An institutional experience of 42 cases in India. Brachytherapy 2010; 9:254-9. [DOI: 10.1016/j.brachy.2009.11.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2009] [Revised: 11/03/2009] [Accepted: 11/05/2009] [Indexed: 10/19/2022]
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Perry DJ, Chan K, Wolden S, Zelefsky MJ, Chiu J, Cohen G, Zaider M, Kraus D, Shah J, Lee N. High-dose-rate intraoperative radiation therapy for recurrent head-and-neck cancer. Int J Radiat Oncol Biol Phys 2009; 76:1140-6. [PMID: 19560882 DOI: 10.1016/j.ijrobp.2009.03.025] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2008] [Revised: 03/05/2009] [Accepted: 03/09/2009] [Indexed: 11/15/2022]
Abstract
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.
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Affiliation(s)
- David J Perry
- Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA
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Curiethérapie des cancers de la tête et du cou (cavum exclu). Cancer Radiother 2008; 12:515-21. [DOI: 10.1016/j.canrad.2008.08.276] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2008] [Accepted: 08/20/2008] [Indexed: 11/24/2022]
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Abstract
Since the inception of this journal in 1948, the understanding of etiologic factors that contribute to and the treatment of head and neck cancer has evolved dramatically. Advances in surgery, radiation therapy, and chemotherapy have improved locoregional control, survival, and quality of life. The outcomes of these treatment modalities have shifted the focus of curative efforts from radical ablation to preservation and restoration of function. This evolution has been documented in the pages of Cancer for the past 6 decades. This review focuses on the evolution of treatment approaches for head and neck cancer and future directions while recognizing the historic contributions recorded within this journal.
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Affiliation(s)
- David M. Cognetti
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Randal S. Weber
- Department of Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, University of Texas, Houston, Texas
| | - Stephen Y. Lai
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
- Department of Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, University of Texas, Houston, Texas
- Department of Pharmacology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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Combination of surgical resection and HDR-brachytherapy in patients with recurrent or advanced head and neck carcinomas. J Craniomaxillofac Surg 2008; 36:285-92. [DOI: 10.1016/j.jcms.2007.08.009] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2007] [Accepted: 08/01/2007] [Indexed: 11/22/2022] Open
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Chen AM, Garcia J, Bucci MK, Chan AS, Kaplan MJ, Singer MI, Phillips TL. Recurrent salivary gland carcinomas treated by surgery with or without intraoperative radiation therapy. Head Neck 2008; 30:2-9. [PMID: 17828788 DOI: 10.1002/hed.20651] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The optimal treatment for patients with locally recurrent carcinomas of the salivary glands is unclear. METHODS Ninety-nine patients underwent salvage surgery for locally recurrent salivary gland carcinomas. Eighty-one (82%) had previously received radiation. Thirty-seven patients (37%) received intraoperative radiation therapy (IORT) to a median dose of 15 Gy (range, 12-18 Gy) at the time of salvage. RESULTS The 1-, 3-, and 5-year estimates of local control after salvage surgery were 88%, 75%, and 69%, respectively. A Cox proportional hazard model identified positive margins (0.01) and the omission of IORT (p = .001) as independent predictors of local failure. The 5-year overall survival was 34%. Distant metastasis was the most common site of subsequent failure, occurring in 42% of patients. CONCLUSIONS IORT significantly improves disease control for patients with locally recurrent carcinomas of the salivary glands. The high rate of distant metastasis emphasizes the need for effective systemic therapies.
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Affiliation(s)
- Allen M Chen
- Department of Radiation Oncology, Head and Neck Surgery, University of California, San Francisco Comprehensive Cancer Center, San Francisco, California 94143, USA
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Narayana A, Cohen GN, Zaider M, Chan K, Lee N, Wong RJ, Boyle J, Shaha A, Kraus D, Shah J, Zelefsky MJ. High-dose-rate interstitial brachytherapy in recurrent and previously irradiated head and neck cancers—Preliminary results. Brachytherapy 2007; 6:157-63. [PMID: 17434110 DOI: 10.1016/j.brachy.2006.12.001] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2006] [Revised: 12/19/2006] [Accepted: 12/19/2006] [Indexed: 11/29/2022]
Abstract
PURPOSE Although high-dose-rate brachytherapy (HDRBT) offers significant advantages over low dose rate brachytherapy, there are scant data on improved local control (LC) and treatment-related complications in patients with recurrent head and neck (H&N) cancers. We report our preliminary results in patients with recurrent H&N cancers treated with interstitial HDRBT. METHODS AND MATERIALS Thirty patients with recurrent H&N cancers were treated with HDRBT between September 2003 and October 2005. Seventy-seven percent (23/30) of the patients had either local or regional recurrence in the area of previous external beam radiation therapy. The treatment sites were oral cavity/oropharynx (11/30), neck (10/30), face/nasal cavity (6/30), and parotid bed (3/30). Whereas 18 patients underwent surgical resection followed by HDRBT, 3 patients were treated with combined external beam radiation and HDRBT, and the remaining 9 were treated with HDRBT alone. The dose and fractionation schedules used were 3.4Gy twice per day (b.i.d.) to 34Gy for postoperative cases, 4Gy b.i.d. to 20Gy when combined with 40-50Gy external beam, and 4Gy b.i.d. to 40Gy for definitive treatment. HDRBT was initiated 5 days after catheter placement to allow for tissue healing. RESULTS With a median followup of 12 months, 6 local recurrences were observed 1-10 months after the procedure. The 2-year LC and overall survival outcomes for the entire group were 71% and 63%, respectively. Patients treated with surgical resection and HDRBT had an improved 2-year LC compared to the patients treated with HDRBT+/-external beam radiation alone (88% vs. 40%, p=0.05). Six Grade II and four Grade III complications were noted in five patients, all observed in the postoperative HDRBT group. CONCLUSION The preliminary results of HDRBT indicate an acceptable LC and morbidity in recurrent H&N cancers. A planned surgical resection followed by HDRBT is associated with improved tumor control in these high-risk patients. Based on these encouraging results, prospective clinical trials are warranted using HDRBT in recurrent H&N cancers to decrease late toxicity.
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Affiliation(s)
- Ashwatha Narayana
- Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
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Chen AM, Bucci MK, Singer MI, Garcia J, Kaplan MJ, Chan AS, Phillips TL. Intraoperative radiation therapy for recurrent head-and-neck cancer: the UCSF experience. Int J Radiat Oncol Biol Phys 2006; 67:122-9. [PMID: 17084543 DOI: 10.1016/j.ijrobp.2006.08.038] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2006] [Revised: 08/16/2006] [Accepted: 08/17/2006] [Indexed: 11/26/2022]
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), 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.
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Affiliation(s)
- Allen M Chen
- Department of Radiation Oncology, University of California, San Francisco, Comprehensive Cancer Center, San Francisco, CA.
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