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. 2019 Jun;11(3):221-226.
doi: 10.5114/jcb.2019.86298. Epub 2019 Jun 28.

Carotid dosimetry after re-irradiation with 131Cs permanent implant brachytherapy in recurrent, resected head and neck cancer

Amanda Walsh  1 , Emily Hubley  2 , Laura Doyle  2 , David Cognetti  1 , Joseph Curry  1 , Voichita Bar-Ad  2 , Adam Luginbuhl  1
Affiliations

Carotid dosimetry after re-irradiation with 131Cs permanent implant brachytherapy in recurrent, resected head and neck cancer

Amanda Walsh et al. J Contemp Brachytherapy. 2019 Jun.

Abstract

Purpose: Permanent seed implant cesium-131 (131Cs) brachytherapy provides highly localized radiation for patients with recurrent head and neck cancer (HNC), who may be ineligible for external beam radiation therapy due to a high-risk of toxicity. As carotid blowout is a concern in the setting of re-irradiation, a dose to the carotid artery was examined for 131Cs brachytherapy implants.

Material and methods: Eleven patients were implanted with 131Cs adjacent to carotid at the time of resection for recurrent HNC. Vascularized tissue flaps were used in some patients. The carotid artery was contoured on the post-implant brachytherapy treatment plan, and the maximum carotid point dose and minimum carotid-seed distances are reported. The incidence of carotid blowout in the follow-up period was also measured.

Results: The maximum carotid dose was 77 ±52 Gy (range, 3-158 Gy). The closest seed to the carotid artery was 0.8 ±0.8 cm (range, 0.2-2.6 cm). One patient without a flap experienced carotid blowout, which was attributed to a non-healing wound rather than to high radiation doses.

Conclusions: Carotid artery doses from 131Cs are reported. Vascularized tissue flaps should be considered when planning 131Cs brachytherapy.

Keywords: brachytherapy; carotid blowout; cesium-131; head and neck cancer; recurrent.

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Conflict of interest statement

Authors report no conflict of interest.

Figures

Fig. 1
Fig. 1
A) Post-implant dose calculation for (B) intraoperative cesium implantation (^) adjacent to carotid (*). C) Pectoralis (Pec) major flap with interposition of thin facial element between carotid and cesium. Muscle bulk of the flap utilized to reconstruction skin and soft tissue of the neck ^ Cesium seed, *carotid artery
Fig. 2
Fig. 2
The dose fall-off from a typical 4-by-3 seed implant of 2.0 U seeds is plotted. The dose gradient is extremely steep close to the seeds
Fig. 3
Fig. 3
The center bar in each box is the maximum point dose to the carotid, Dmax. The upper and lower extends of the boxes are the Dmax values to the structures obtained by expanding and contracting the carotid isotropically by 0.5 mm. Expansion and contraction yields a much larger deviation in dose in the high dose region due to the steep dose gradient close to the seeds
See this image and copyright information in PMC

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