Mortality and morbidity with intraoperative radiotherapy for head and neck cancer

To critically evaluate the morbidity and mortality associated with intraoperative radiation therapy (IORT). IORT allows the delivery of large single-doses of radiation to a visible tumor bed with exclusion (or shielding) of critical normal structures from the treatment field. Morbidity and mortality associated with IORT has been directly studied in abdominal malignancies, but only briefly mentioned in the head and neck literature.

At the Arthur G. James Cancer Hospital, The Ohio State University Medical Center, 53 patients with advanced head and neck cancer were treated with surgical resection and IORT. Twenty of these patients had intraoperative high-dose-rate (HDR) brachytherapy, whereas the remaining 33 received intraoperative electron beam therapy. All patients received 7.5 to 20 Gy of radiation. Those treated were reviewed evaluating perioperative mortality, major and minor complications, and length of hospital stay. All patients have been followed at least 3 months postoperatively.

There were no perioperative deaths. Additionally, there was no increase in the number of complications or length of hospital stay associated with the use of IORT. The mean length of hospital stay was 13.0 days. The major complication rate was 16.8%. Of the major complications, 9% were medical and not related to the surgical site. The minor complication rate was 8%.

As we strive to increase control of advanced head and neck cancer, IORT may play an exciting role for intensifying the therapy. At this institution, IORT did not add to the mortality or morbidity of an aggressive multimodality treatment schema.