Perioperative high-dose-rate brachytherapy (PHDRB) in previously irradiated head and neck cancer: Initial results of a Phase I/II reirradiation study

Martínez-Monge, Rafael; Alcalde, Juan; Concejo, Carlos; Cambeiro, Mauricio; Garrán, Cristina

doi:10.1016/j.brachy.2005.11.003

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Volume 5, Issue 1 , Pages 32-40, January 2006

Perioperative high-dose-rate brachytherapy (PHDRB) in previously irradiated head and neck cancer: Initial results of a Phase I/II reirradiation study

Rafael Martínez-Monge
- Department of Oncology, University of Navarra Clinic, University of Navarra, Pamplona, Spain
- Corresponding author. Department of Oncology, University of Navarra Clinic, University of Navarra, Avda Pío XII s/n., Pamplona, Navarra, Spain E-31080. Tel.: +34-948-255400; fax: +34-948-255500.
Juan Alcalde
- Department of Otolaryngology, University of Navarra Clinic, University of Navarra, Pamplona, Spain
Carlos Concejo
- Department of Maxillofacial Surgery, University of Navarra Clinic, University of Navarra, Pamplona, Spain
Mauricio Cambeiro
- Department of Oncology, University of Navarra Clinic, University of Navarra, Pamplona, Spain
Cristina Garrán
- Department of Oncology, University of Navarra Clinic, University of Navarra, Pamplona, Spain

Received 29 September 2005; received in revised form 10 November 2005; accepted 17 November 2005.

Abstract

Background

This study was undertaken to determine the feasibility of salvage surgery and perioperative high-dose-rate brachytherapy (PHDRB) at the dose/fractionation schedule proposed in patients with previously irradiated, recurrent head and neck cancer or second primary tumors arising in a previously irradiated field.

Methods and materials

Twenty-five patients were treated with surgical resection and PHDRB. The PHDRB dose was 4Gy b.i.d.×8 (32Gy) for R0 resections and 4Gy b.i.d.×10 (40Gy) for R1 resections. Further external beam radiotherapy or chemotherapy was not given.

Results

Resections were categorized as R0 (negative margins of at least 10mm) in 3 patients (12.0%) and R1 (negative margins of less than 10mm or microscopically positive margins) in 22 (88.0%). Twelve patients with R1 resections had microscopically positive margins (48%), and 10 patients had close margins (40%), with a median of 2.0mm. Ten patients (40.0%) developed Radiation Therapy Oncology Group Grade 3 or greater toxicity. Seven patients (28%) presented complications requiring a major surgical procedure. Four of these complications appeared in the immediate postoperative period and were surgical in nature (flap failure, n=2; fistula, n=2), and the other three were mainly related to the brachytherapy procedure (n=2) or the radiation dose delivered (n=1). One patient died on postoperative day 11 due to bleeding. After a median followup of 14 months, the 4-year local control rate and overall survival were 85.6% and 46.4%, respectively.

Conclusions

Surgical salvage and PHDRB at the dose/fractionation proposed are feasible in this high-risk population. Toxicity is high, but not substantially different from other reirradiation series. Four-year local control results are encouraging taking into account that 22 of 25 patients (88%) had either close or microscopically positive margins.

Keywords: Head and neck cancer, Prior radiation therapy, Reirradiation, Perioperative, High-dose-rate, Brachytherapy