A systematic review of treating recurrent head 
and neck cancer: a reintroduction of brachytherapy with or without surgery

Rodin, Julianna; Bar‐Ad, Voichita; Cognetti, David M.; Curry, Joseph; Johnson, Jennifer M.; Zender, Chad; Doyle, Laura; Kutler, David I.; Leiby, Benjamin E.; Keane, William M.; Luginbuhl, Adam

doi:10.5114/jcb.2018.79399

Cited by 32 publications

(26 citation statements)

References 48 publications

(120 reference statements)

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“…Surgical resection, when feasible, remains the mainstay treatment for recurrent HNC, and intraoperative interstitial brachytherapy delivered as an adjuvant treatment for this group of patients may improve the treatment outcome and may be associated with fewer complications, when compared with EBRT re-irradiation [30,31].…”

Section: Discussionmentioning

confidence: 99%

“…Brachytherapy can be delivered via permanent implants or via the insertion of high-activity radioisotopes through removable catheters (using high-dose-rate brachytherapy or pulsed-dose-rate brachytherapy). Permanent implants may be more appropriate and advantageous for recurrent HNC patients, as their recurrences often occur in irregular surfaces that may not be suitable for or may pose challenges for catheter-based brachytherapy [31,32].…”

Section: Discussionmentioning

confidence: 99%

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Single institution implementation of permanent 131Cs interstitial brachytherapy for previously irradiated patients with resectable recurrent head and neck carcinoma

Bar‐Ad

Hubley

Luginbuhl

et al. 2019

jcb

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Purpose: Permanent interstitial brachytherapy is an appealing treatment modality for patients with locoregional recurrent, resectable head and neck carcinoma (HNC), having previously received radiation. Cesium-131 (131 Cs) is a permanent implant brachytherapy isotope, with a low average photon energy of 30 keV and a short half-life of 9.7 days. Exposure to medical staff and family members is low; patient isolation and patient room shielding are not required. This work presents a single institution's implementation process of utilizing an intraoperative, permanent 131 Cs implant for patients with completely resected recurrent HNC. Material and methods: Fifteen patients receiving 131 Cs permanent seed brachytherapy were included in this analysis. The process of pre-planning, selecting the dose prescription, seed ordering, intraoperative procedures, post-implant planning, and radiation safety protocols are described. Results: Tumor volumes were contoured on the available preoperative PET/CT scans and a pre-implant treatment plan was created using uniform source strength and uniform 1 cm seed spacing. Implants were performed intraoperatively, following tumor resection. In five of the fifteen cases, intraoperative findings necessitated a change from the planned number of seeds and recalculation of the pre-implant plan. The average prescription dose was 56.1 ±6.6 Gy (range, 40-60 Gy). The average seed strength used was 2.2 ±0.2 U (3.5 ±0.3 mCi). Patients returned to a recovery room on a standard surgical floor and remained inpatients, without radiation safety restrictions, based on standard surgical recovery protocols. A post-implant treatment plan was generated based on immediate post-operative CT imaging to verify the seed distribution and confirm delivery of the prescription dose. Patients were provided educational information regarding radiation safety recommendations. Conclusions: Cesium-131 interstitial brachytherapy is feasible and does not pose major radiation safety concerns; it should be considered as a treatment option for previously irradiated patients with recurrent, resectable HNC.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Single institution implementation of permanent 131Cs interstitial brachytherapy for previously irradiated patients with resectable recurrent head and neck carcinoma

Bar‐Ad

Hubley

Luginbuhl

et al. 2019

jcb

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“…Cumulative knowledge of interstitial brachytherapy (ISBT) in other anatomical sites [ 42 , 43 , 44 , 45 , 46 , 47 ] proved that if the thickness of the tumor is larger than 5 mm, it is unreachable with conventional ICBT, and if interstitial needle application is possible, a boost with HDR-ISBT would be a better option to escalate local dose, while minimizing unnecessary irradiation to surrounding normal tissues [ 26 , 27 , 28 ]. A group from the Thomas Jefferson University reported the usefulness of salvage surgery combined with re-irradiation with intraoperative 131 Cs permanent brachytherapy implant in recurrent head and neck cancer [ 48 , 49 ]. Although, the number of patients investigated in the study was as small as eleven and because the dose fall-off gradient adjacent to the brachytherapy source was extremely steep, only limited volume of carotid artery (less than 1 mm 3 ) received 19 ±10 Gy, which was acceptable [ 48 ], suggesting that brachytherapy is a suitable modality to deliver high dose close to critical structures.…”

Section: Discussionmentioning

confidence: 99%

Image-guided interstitial brachytherapy boost for nasopharyngeal carcinoma: technical aspects

Murakami

Cheng

Yoshimoto³

et al. 2020

jcb

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Nasopharyngeal cancer generally responds well to concurrent chemoradiotherapy (CCRT). However, there is a small group of patients who respond poorly to CCRT, and experience local residual tumor or local relapse. Although several attempts have been performed to such a group of patients including re-irradiation with external beam radiation therapy (EBRT) or salvage surgery, clinical results remain unsatisfactory. Intracavitary brachytherapy (ICBT) boost after CCRT with EBRT has been explored, however, its efficacy is limited to those with superficial residual tumors. For those residual tumors thickness with more than 5 mm, interstitial brachytherapy (ISBT) boost would be an appropriate modality of choice. Here, we describe technical aspects of the high-dose-rate interstitial brachytherapy (HDR-ISBT) boost for nasopharyngeal cancer (NPC) patients who responded poorly to the CCRT with EBRT.

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“…Permanent interstitial brachytherapy has been cumulatively used and resulted in good outcomes for primary or adjuvant treatment of prostate cancer, gynecologic malignancies, certain head and neck tumors, and nervous system tumors [1,2,3,4,5,6]. The therapeutic effect of radioactive iodine-125 ( 125 I) seeds (RIS) interstitial implantation brachytherapy depends primarily on dose distribution.…”

Section: Purposementioning

confidence: 99%

Dosimetry verification of 3D-printed individual template based on CT-MRI fusion for radioactive 125I seed implantation in recurrent high-grade gliomas

Liu¹,

Wang²,

Wang³

et al. 2019

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Purpose: To verify the accuracy and efficacy of three-dimensional printing individual template (3D-PIT) with computed tomography-magnetic resonance imaging (CT-MRI) fusion for radioactive iodine-125 (125 I) seed implantation in high-grade brain gliomas. Material and methods: Between June 2017 and June 2018, 16 patients with recurrent high-grade gliomas (rHGG) underwent radioactive seed implantation with 3D-PIT. The prescribed dose was 120-140 Gy. We compared the dose distribution of the postoperative plan with the preoperative plan. Dose parameters included D 90 , V 100 , V 200 , conformity index (CI), and external index of the target volume (EI). Local control and early complications were also analyzed. Results: Sixteen treatment areas were reported in our study. Median gross tumor volume (preoperative) of patients was 64.2 cm 3 , median needle number was 8, and median number of implanted 125 I seeds was 60. For postoperative plans, the median D 90 , V 100 , and V 200 was 152.1 Gy, 96.8%, and 49.1%, respectively, and 151.7 Gy, 97.0%, and 48.9%, respectively, in preoperative plans. Comparing with the preplanned cases, the dose of the target volume was slightly higher; the high-dose area of the target volume was larger in postoperative cases, but the difference was not statistically significant (p > 0.05). Actual dose conformity of the target volume was greater than preplanned, and the difference was not statistically significant (p > 0.05). Local control was 81.25% and 75% at 3 and 6 months after implantation, respectively. No serious early toxicities were observed. Conclusions: 3D-PIT based on the CT-MRI fusion images can result in good accuracy for positioning and dose distribution in radioactive seed implantation for treatment of rHGG.

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A systematic review of treating recurrent head and neck cancer: a reintroduction of brachytherapy with or without surgery

Cited by 32 publications

References 48 publications

Single institution implementation of permanent 131Cs interstitial brachytherapy for previously irradiated patients with resectable recurrent head and neck carcinoma

Single institution implementation of permanent 131Cs interstitial brachytherapy for previously irradiated patients with resectable recurrent head and neck carcinoma

Image-guided interstitial brachytherapy boost for nasopharyngeal carcinoma: technical aspects

Dosimetry verification of 3D-printed individual template based on CT-MRI fusion for radioactive 125I seed implantation in recurrent high-grade gliomas

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