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[Interstitial irradiation by 192Ir seed assemblies in fixed cervical lymph node metastases].
Gan No Rinsho. Japan Journal of Cancer Clinics
|April 1, 1987
Summary
External beam radiation followed by iridium-192 (192Ir) interstitial implants improved local control for fixed cervical lymph node metastases. Optimal timing and dose are crucial for better therapeutic ratios.
Area of Science:
- Radiation Oncology
- Head and Neck Cancer Treatment
Context:
- Fixed cervical lymph node metastases present a significant challenge in head and neck cancer management.
- External irradiation followed by interstitial brachytherapy is a treatment modality explored for these advanced cases.
Purpose:
- To evaluate the efficacy and safety of combined external irradiation and 192Ir interstitial implants for fixed cervical lymph node metastases.
- To determine optimal treatment timing and dose fractionation for improved local tumor control and therapeutic ratio.
Summary:
- Eleven patients received external irradiation followed by 192Ir seed-assemblies (one patient received 137Cs needles).
- Local tumor responses included 4 complete responses (CR), 6 partial responses (PR), and 1 no change (NC).
- Treatment intervals exceeding one month between external and interstitial irradiation correlated with poor local control, suggesting optimal timing is critical.
Impact:
- The study demonstrates that interstitial implants, particularly 192Ir, can improve local control and the therapeutic ratio for fixed cervical lymph node metastases.
- A recommended treatment schedule involves 40 Gy over 4 weeks external irradiation, followed by a 2-week interval, then 40-50 Gy over 4-5 days with 192Ir interstitial implants.
- Acute tolerance was good, with minimal late morbidities, indicating a favorable safety profile for this combined approach.