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Agarwal A, Pinto J, Renslo B, Bar-Ad V, Taleei R, Luginbuhl A. Feasibility of collagen matrix tiles with cesium-131 brachytherapy for use in the treatment of head and neck cancer. Brachytherapy 2023; 22:120-124. [PMID: 36369194 DOI: 10.1016/j.brachy.2022.09.160] [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: 06/12/2022] [Accepted: 09/28/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Locoregional failure is a unique and challenging problem in head and neck cancer with controversy surrounding the use of re-irradiation in the treatment. We aimed to evaluate the dosimetry and technical parameters in utilizing a collagen matrix with embedded Cesium-131 (Cs-131) radioactive isotope seeds as it relates to dose distribution and dose to carotid artery. METHODS AND MATERIALS Cadaveric feasibility study randomizing Cs-131 strands alone or Cs-131 with collagen matrix to be placed into neck dissection defects. For the dose computation, physicists employed the TG-43 dosimetry calculation algorithm with a point source assumption to compute the dose. Carotid arteries were contoured in MIM-Symphony software and the carotid artery maximum and mean doses were calculated in accordance with TG-43 specifications. Ease of use of collagen matrix tiles on a 7-point Likert scale and mean radiation dose to the carotid artery. RESULTS Ease of use score was higher in collagen matrix compared to stranded seeds with a mean score of 6.3 +/- 1.2 compared to 4.5 +/- 0.87. Time of implantation was statistically significantly, p = 0.031, lower in the collagen matrix group (M = 5.17 min, SD = 4.62) compared to stranded seeds (M = 15.83 min, SD = 3.24). Mean radiation dose to the carotid artery was 62.8 Gy +/- 9.46 in the collagen matrix group compared to 108.2 Gy +/- 55.6 in the traditional Cs-131 seeds group. CONCLUSIONS We present a feasibility and concept cadaveric study using a collagen matrix with Cesium-131 demonstrating preliminary evidence to support its ease of use, decreased time to implantation, and decreased dose delivered to the carotid artery.
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Affiliation(s)
- Aarti Agarwal
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University Hospitals, Philadelphia, PA.
| | - Joseph Pinto
- Department of Radiation Oncology, Thomas Jefferson University Hospitals, Philadelphia, PA
| | - Bryan Renslo
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University Hospitals, Philadelphia, PA
| | - Voichita Bar-Ad
- Department of Radiation Oncology, Thomas Jefferson University Hospitals, Philadelphia, PA
| | - Reza Taleei
- Department of Radiation Oncology, Thomas Jefferson University Hospitals, Philadelphia, PA.
| | - Adam Luginbuhl
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University Hospitals, Philadelphia, PA
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Kharouta M, Zender C, Podder T, Rezaee R, Lavertu P, Fowler N, Thuener J, Li S, Clancy K, Xu Z, Yao M. Permanent Interstitial Cesium-131 Brachytherapy in Treating High-Risk Recurrent Head and Neck Cancer: A Prospective Pilot Study. Front Oncol 2021; 11:639480. [PMID: 33816283 PMCID: PMC8012839 DOI: 10.3389/fonc.2021.639480] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 01/25/2021] [Indexed: 11/25/2022] Open
Abstract
Purpose/Objectives To establish the feasibility and safety of intraoperative placement of cesium-131 (Cs-131) seeds for re-irradiation in recurrent head and neck cancer (HNC). Methods Patients with resectable recurrent HNC who were deemed to have a high risk of second recurrence were eligible. Immediately after tumor extirpation, seeds were implanted in the surgical bed based on the preoperative treatment plan with intraoperative adjustment. The surgical bed and the seeds were covered with a regional flap or microvascular free flap. A CT of the neck was obtained on postoperative day 1 for evaluation of the postoperative dose distribution. Patients were followed 1 and 3 months after surgery, then every 3 months in the first 2 years. Results From November 2016 to September 2018, 15 patients were recruited and 12 patients received treatment per protocol. For the patients who had implants, the sites of initial recurrence included 10 neck alone, 1 neck and larynx, and 1 neck/peristomal. The median follow-up was 21.4 months. After surgery, patients remained hospitalized for a median of 6 days. There were no high-grade toxicities except two patients with wound complications requiring wound care. Eight patients had recurrences, three locoregional alone, three distant alone, and two with both locoregional and distant recurrences. Only one patient had an in-field failure. Five patients died, with 1- and 2-year overall survival of 75 and 58%. Conclusions Cs-131 implant after surgical resection in recurrent HNC is feasible and safe. There were no unexpected severe toxicities. Most failures were out-of-field or distant. Clinical Trial Registration ClinicalTrials.gov, identifier NCT02794675.
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Affiliation(s)
- Michael Kharouta
- Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, OH, United States
| | - Chad Zender
- Department of Otolaryngology Head and Neck Surgery, University of Cincinnati School of Medicine, Cincinnati, OH, United States
| | - Tarun Podder
- Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, OH, United States
| | - Rod Rezaee
- Department of Otolaryngology Head and Neck Surgery, University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, OH, United States
| | - Pierre Lavertu
- Department of Otolaryngology Head and Neck Surgery, University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, OH, United States
| | - Nicole Fowler
- Department of Otolaryngology Head and Neck Surgery, University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, OH, United States
| | - Jason Thuener
- Department of Otolaryngology Head and Neck Surgery, University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, OH, United States
| | - Shawn Li
- Department of Otolaryngology Head and Neck Surgery, University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, OH, United States
| | - Kate Clancy
- Department of Otolaryngology Head and Neck Surgery, University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, OH, United States
| | - Zhengzheng Xu
- Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, OH, United States
| | - Min Yao
- Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, OH, United States
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