Customized individual applicators for endocavitary brachytherapy in patients with cancers of the nasal cavity, sinonasal region and nasopharynx

Abstract

Brachytherapy has become an established therapeutic regimen for primary, persistent, recurrent and metastatic tumour disease in the head and neck region. This study presents the authors' preliminary experience with intracavitary brachytherapy by means of an individual silicone applicator in the treatment of patients with nasal, sinonasal, orbital and nasopharyngeal cancer. Between January 2001 and January 2013, twenty patients with cancer of the nasal cavity, the paranasal sinuses and nasopharynx underwent surgery and intracavitary brachytherapy with the aid of an individually manufactured silicone applicator in the Department of Otolaryngology, Head and Neck Surgery and in the Department of Radiotherapy and Radiooncology at the Saarland University Medical Center of Homburg, Germany. The tumour was localized in the nasal cavity/paranasal sinuses (15) affecting the orbit twice and the nasopharynx (5). There were 14 patients with squamous cell carcinoma, 2 patients with mixed tumours and one patient with adenocarcinoma, adenoid cystic carcinoma, mucosal melanoma or plasmocytoma. The majority of the patients presented with advanced disease (T3 or T4 tumours). In 18/20 patients, brachytherapy was performed as a boost technique, in the remaining two solely because of a previous radiation series. All surgical interventions were performed endonasally. Three to six weeks after surgery, a cast of the nasal cavity was created under general anaesthesia. Subsequently, an individual brachytherapy silicon applicator with two to four plastic tubes was manufactured. The radiation therapy was applied using the Ir-192 high-dose-rate-afterloading method (total dose 10-20 Gy) in two to five sessions, additionally in 18/20 patients a percutaneous radiotherapy with a total dose of 30-60 Gy was applied. After a mean duration of follow-up of 2 years, 7/20 patients experienced a local progression, 5/19 a regional recurrence in the neck nodes and 4/19 distant metastases. The 2-year survival was 57.3 %. No serious complications were reported. The silicone applicator was well tolerated by all patients. Because of the complexity of the sinonasal anatomy with the finding of mainly advanced tumours, the presented individual silicone brachytherapy applicator has proven to be useful and meaningful for endocavitary brachytherapy of malignancies of the nasal cavities, paranasal sinuses and nasopharynx.

Successful salvage treatment of refractory recurrence of maxillary sinus carcinoma using image-guided high-dose-rate interstitial brachytherapy

“…Due to the limited therapeutic options, the management of previously pre-treated refractory recurrent maxillary sinus carcinoma remains a challenging problem. Some exploratory studies have focused on the application of brachytherapy [ 14 , 15 , 16 ]. Huang et al .…”

Cesium-131 Brachytherapy Seeds for the Treatment of Sinonasal Carcinosarcoma: A Case Report and Literature Review

“…In addition, a removable, temporary instead of a permanent source may be used in order to provide a lower risk of toxicity [30]. The radiation source can be implanted within the tumor mass (interstitial brachytherapy) or placed within a body cavity (intracavitary brachytherapy) and deliver radiation doses with high precision [18]. Utilization of BRT can thereby minimize the incidence of complications associated with radiation-induced adjacent tissue damage while treating and preventing progression of residual micro tumor.…”

“…Additionally, resection of skull base tumors is also often complicated by proximity or extension into critical structures resulting in suboptimal outcomes [13,14]. Cesium-131 (Cs-131) Brachytherapy (BRT) is an effective and highly conformal contemporary technique for administering further radiation in a previously irradiated field while limiting toxicity in the treatment of head and neck cancer [15][16][17][18][19][20].…”