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Outcomes of Intraoperative Radiation Therapy in the Treatment of Advanced Head and Neck Cancer
Author(s) -
Joos Nathan,
Coleman Brian,
McNulty Beth,
Bumpous Jeffrey
Publication year - 2010
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1002/lary.21218
Subject(s) - medicine , otorhinolaryngology , head and neck surgery , head and neck cancer , head and neck , general surgery , radiation therapy , surgery
Intraoperative radiation (IORT) therapy has gained recent popularity as a treatment modality in patients suffering from head and neck cancers. Traditional external beam radiation therapy delivers multiple staggered insults to cells by direct and indirect mechanisms of damage, allowing healthy tissue to enact its superior DNA repair mechanisms to increase chances of survival, while malignant cell populations decline in a logarithmic fashion. Conversely, IORT consists of a single high dose exposure, on the order of 12-20 Gy, that attempts to spare healthy tissue by directly shielding it from the field during an open operation, rather than by the conventional mechanisms employed in EBRT. Stripped of the opportunity to enact any form of cellular repair, malignant tissue receives an estimated EBRT delivery equivalent to three times the actual IORT dose given, while protecting neighboring tissue from insult. A retrospective chart review identified 30 patients with stage III/IV carcinoma of the head or neck that were selected for treatment by IORT from 2002-present with at least 2 years of uninterrupted follow up. A match paired population of 30 patients with similar tumor profiles and stages treated with resection and other treatment modalities (EBRT, chemotherapy) was selected over the same time span. Patients were followed for disease free and overall survival as well as for any complications of treatment. Cases were divided into 3 classes based upon their pathology reports on tumor resection: Negative margin, close margin or microscopic residual disease, gross positive margins The outcomes of these groups were plotted using Kaplan-Meier survival curves, and compared for statistical significance through Cox regression analysis.