Cesium-131 brachytherapy in high risk and recurrent head and neck cancers: first report of long-term outcomes

Abstract

Purpose: The feasibility and efficacy of re-irradiation using contemporary radiation techniques to treat recurrent head and neck cancer has been demonstrated but the role of brachytherapy is unclear. Here we describe the use of (131)Cs brachytherapy with concurrent salvage surgery in 18 patients.

Material and methods: Eligible patients underwent maximal gross resection of the tumor with implantation of brachytherapy seeds delivering a minimum dose of 80 Gy to the tumor bed. Rates of overall survival, locoregional progression free survival, disease-free survival, and radiation-induced toxicity were analyzed.

Results: Retrospective Kaplan-Meier analysis shows median overall survival was 15 months and disease free survival was 12 months. Two patients developed grade 3 toxicity; all other complications were grade 1-2 with no grade 4 or 5 complications.

Conclusions: Compared to prior literature, our study shows comparable rates of survival with a decreased rate of radiation-induced toxicity.

Keywords: 131Cs; brachytherapy; head and neck cancer; recurrence.

Fig. 1

Implantation of tumor bed with ¹³¹Cs mesh

Fig. 2

A) Implant from patient #17 with B) dose volume histograms (DVH). Maximum esophagus and spinal cord dose was 22.26 Gy and 19.26 Gy, respectively. C) Implant from patient #13 with D) DVH. Maximum larynx, esophagus, and spinal cord dose was 53.43 Gy, 12.68 Gy, and 4.24 Gy, respectively

Fig. 3

Overall survival in entire patient population (n = 18)

Fig. 4

Locoregional progression free survival in entire patient population (n = 18)

Fig. 5

Disease free survival for entire patient population (n = 18)