Tolerance of the carotid-sheath contents to brachytherapy: an experimental study

Tumor invasion of the carotid artery is a potential indication for brachytherapy, which delivers a high dose of irradiation to residual tumor while limiting the dose to adjacent healthy tissues. The tolerance of carotid-sheath contents to varying doses of brachytherapy, however, has not been clearly established. In order to evaluate brachytherapy effects on carotid-sheath contents, after-loading catheters were implanted bilaterally in 3 groups of 6 rabbits each (18 rabbits). Iridium 192 brachytherapy doses of either 5000 cGy (rad), 9000 cGy, or 13,000 cGy were delivered unilaterally, with the contralateral neck serving as a nonirradiated control in each animal. There were no carotid ruptures and wound healing was normal. Two animals from each group were killed at 6, 20, and 48 weeks. Even at the highest dose (13,000 cGy), nerve conduction studies performed on the vagus nerve prior to sacrifice revealed no increased latency, histologic changes were minimal, and carotid arteries were patent. These observations suggest that the carotid-sheath contents in healthy rabbits could tolerate high doses (up to 13,000 cGy) of low-dose-rate interstitial brachytherapy without complications.