Interstitial high-dose-rate brachytherapy combined with cervical dissection on head and neck cancer

The literature is scarce regarding the use of interstitial high-dose-rate brachytherapy (I-HDR) as adjuvant treatment of the cervical region, and most reports are focused on primary tumors of the mobile tongue and oropharynx. We evaluated the outcome and morbidity related to an institutional treatment policy, using I-HDR as the sole adjuvant treatment or in combination with external beam radiotherapy (EBRT) at the Departments of Radiation Oncology and Head and Neck Surgery, Hospital do Cancer, Sao Paulo, Brazil.

From October 1994 to December 2003, charts of 42 patients who had biopsy-proven cervical head and neck cancer, with a median follow-up of 36 months (range, 8-111 months), were reviewed. The median age of the patients was 55 years (range, 31-76 years), and the male/female ratio was 4.25:1.00. Thirty-five patients had previous irradiation with EBRT, with doses ranging from 30 Gy to 65 Gy (median, 52 Gy). The total dose of I-HDR ranged from 12 Gy to 48 Gy (median, 24 Gy), given in three to 14 fractions (median, 6 fractions) in 2 to 8 days (median, 4 days).

The total treatment time ranged from 19 to 83 days (median, 35 days). The 5- and 8-year overall survival (OS) rates were 52.5% and 48.1%, respectively; and the relapse-free survival (RFS) rates were 48.5% and 38.1%, respectively. The only statistically significant prognostic factor for RFS and OS at 5 and 8 years was margin status (p = .0050). Four patients (9.5%) had late adverse side effects, such as local dehiscence (n = 2), local ulcer (n = 1), and extensive neck fibrosis (n = 1), not related to a higher dose to the skin or graft.

These results suggest that I-HDR can be recommended in selected patients with first presentation lesions, local recurrences, or second primary carcinomas, even with a previous course of EBRT, but further studies are eagerly awaited to delineate the optimum schedule for this combination-treatment modality.