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The role of interstitial brachytherapy with salvage surgery for the management of recurrent head and neck cancers
Author(s) -
Kupferman Michael E.,
Morrison William H.,
Santillan Alfredo A.,
Roberts Dianna,
Diaz Eduardo M.,
Garden Adam S.,
Weber Randal
Publication year - 2007
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.22648
Subject(s) - medicine , brachytherapy , neck dissection , surgery , head and neck cancer , perioperative , radiation therapy , dissection (medical) , salvage therapy , head and neck , osteoradionecrosis , retrospective cohort study , soft tissue , cancer , chemotherapy
BACKGROUND The role of interstitial brachytherapy (IBT) in the salvage surgical management of regional lymphatic metastases for head and neck cancer has not been defined to date. To further explore its therapeutic benefit in the management of head and neck squamous cell carcinoma, the authors reviewed their experience utilizing IBT at the M. D. Anderson Cancer Center. METHODS A retrospective chart review of all patients who were received IBT for cervical recurrences of head and neck cancer was undertaken. Twenty‐two patients were identified; all patients underwent neck dissection and intraoperative placement of afterloading catheters as part of the salvage treatment. Soft tissue reconstruction was performed when necessary. The duration and dosage of salvage brachytherapy was reviewed, and the overall disease‐free survival rates were determined. RESULTS All patients had been treated with external beam radiation therapy prior to recurrence, with an average dose of 65 grays (Gy), and 46% of patients had undergone prior neck dissection. The median time to regional recurrence after definitive treatment was 30 months. Soft tissue coverage of the surgical bed with a muscle flap, most commonly a pectoralis major flap, was performed in 19 of 22 patients. The median IBT dose was 60 Gy over a total duration of 4 days. Postoperative complications were few, and there were no perioperative deaths. Recurrences in the reirradiated necks occurred in 27% of patients. CONCLUSIONS Regional recurrences are common after multimodality treatment for head and neck cancer and are challenging to manage. Although its role has not been defined clearly, salvage neck dissection with IBT is beneficial in the management of recurrent lymphatic metastases of upper aerodigestive tract carcinomas. Cancer 2007. © 2007 American Cancer Society.

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