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Nonsurgical alternative therapy for bulky advanced head and neck tumors
1Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, Conn., USA.
Objective:
To rapidly induce symptomatic relief and local tumor control in bulky advanced head and neck tumors without surgery.
Design:
A retrospective analysis of the results with palladium 103-labeled or iodine 125-labeled brachytherapy (BT) and adjunctive external beam radiation therapy (EBRT); a survival analysis by the Kaplan-Meier method; and a comparison of results between the BT/EBRT and EBRT/BT (or BT alone) groups by the log-rank test. A nonsurgical alternative therapy was given to a total of 51 patients who presented with tumors of more than 100 cm3 in volume.
Results:
Moderate to complete symptomatic relief was observed in 31 (61%) of 51 patients. Seven (33%) of 21 patients in the BT/EBRT group and two (7%) of 30 in the EBRT/BT group were recurrence-free at 36 months. The difference was significant by the log-rank test. Cause-specific and overall 36-month survivals were 23% and 5%, respectively.
Conclusion:
Cure rate by conventional therapy in bulky advanced head and neck tumors is dismal. The palladium 103- or iodine 125-BT/EBRT offers good symptomatic relief and an acceptable probability of recurrence-free survival.