Head and neck cancer reirradiation with interstitial high‐dose‐rate brachytherapy

Hegde, John V.; Demanes, D. Jeffrey; Veruttipong, Darlene; Chin, Robert; Park, Sang-June; Kamrava, Mitchell

doi:10.1002/hed.25137

Cited by 16 publications

(12 citation statements)

References 20 publications

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“…In recent years, radiotherapy (RT) has become increasingly popular as a treatment for HNC patients. RT techniques include intensity-modulated radiotherapy (IMRT), stereotactic body radiation therapy, particle therapy, and high-dose-rate brachytherapy (1). The typical radiation regimen for HNC patients comprises a dose of 2 Gy per day for 5-7 continuous weeks, with a total cumulative dose of 60-70 Gy (2).…”

Section: Introductionmentioning

confidence: 99%

Status of Treatment and Prophylaxis for Radiation-Induced Oral Mucositis in Patients With Head and Neck Cancer

et al. 2021

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Radiation-induced oral mucositis (RIOM) is one of the most frequent complications in head and neck cancer (HNC) patients undergoing radiotherapy (RT). It is a type of mucosal injury associated with severe pain, dysphagia, and other symptoms, which leads to the interruption of RT and other treatments. Factors affecting RIOM include individual characteristics of HNC patients, concurrent chemoradiation therapy, and RT regimen, among others. The pathogenesis of RIOM is not yet fully understood; however, the release of inflammatory transmitters plays an important role in the occurrence and development of RIOM. The five biological stages, including initiation, primary damage response, signal amplification, ulceration, and healing, are widely used to describe the pathophysiology of RIOM. Moreover, RIOM has a dismal outcome with limited treatment options. This review will discuss the epidemiology, pathogenesis, clinical appearance, symptomatic treatments, and preventive measures related to this disease. We hope to provide a reference for the clinical treatment and prevention of RIOM in HNC patients after RT.

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Section: Introductionmentioning

confidence: 99%

Status of Treatment and Prophylaxis for Radiation-Induced Oral Mucositis in Patients With Head and Neck Cancer

et al. 2021

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“…As BT offers one of the best dose distributions in radiotherapy: a high radiation dose to the target volume while better protecting surrounding previously irradiated healthy tissues. Many studies describe BT as a ReRT equipment in local recurrences of previously irradiated prostate (5), gynecological (6-10), breast (11), head and neck (12)(13)(14), rectal cancers (15), brain tumor (16), sarcoma (17), or secondary primary cancers (18) occurring in-field. Generally, current data confirm that BT ReRT is feasible and has acceptable toxicity (18).…”

Section: Discussionmentioning

confidence: 99%

“…Local recurrence of breast (5) or prostate cancer (11) could expect long life expectancy, and therefore, an individualized curative approach is recommended to maintain the patients' quality of life. On the other hand, local recurrence of head and neck (12)(13)(14) and brain cancers (16) often has a grim prognosis, with anticipating comorbidities resulting in rather palliative intension to hinder the active management.…”

Section: Discussionmentioning

confidence: 99%

A national surveillance study of the current status of reirradiation using brachytherapy in Japan

et al. 2021

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This study aimed to explore the current status and pattern of practice for reirradiation using brachytherapy (ReRT-BT) through a survey in Japan. MATERIALS AND METHODS:We distributed an e-mail-based questionnaire to 153 institutions equipped with high-dose-rate brachytherapy facilities. RESULTS: We received responses from 76 institutions (49.7%). Forty-three of these institutions performed ReRT-BT and 42 institutions (55%) performed ReRT-BT during 2009e2018. However, 29 of the 42 institutions (69%) reported difficulty in obtaining ReRT-BT case information from their respective databases. Almost all the institutions encountered insufficient database system to extract details about the ReRT-BT cases. Responses from 33 institutions included the number of ReRT-BT cases; this increased from 90 in the period 2009e2013 (institution median 5 0.5; 0e 16) to 172 in the period 2014e2018 (institution median 5 2; 0e26). Nine institutions had to perform ReRT-BT for more than one case per year. The major location for cancer treatment was the pelvis (94%), followed by the head and neck (5%) and others (1%). In six site-specific scenarios, barring uterine corpus cancer recurrence, more than 90% of radiation oncologists agreed to perform ReRT-BT, whereas other areas (head and neck, prostate, and rectal cancer) gained 16e37% agreement. CONCLUSIONS: This decade saw an increase in the number of ReRT-BT cases in Japan and radiation oncologists' interest in ReRT-BT as a viable therapeutic option. However, scarce availability, immature education system, and insufficient database system are barriers to further consensus building.

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“…Inoperable primary or secondary tumors (metastases) are frequently treated with interstitial brachytherapy, which allows for application of high radiation doses to a lesion, with a steep dose fall-off outside of the target and sparing surrounding (healthy) tissue [1,2,3,4]. Multiple brachytherapy treatment modalities are available, including catheter-based high-dose-rate (HDR) afterloading brachytherapy with 192 Ir sources or permanent implantation with 125 I seeds (PSI), as the most used methods [5].…”

Section: Purposementioning

confidence: 99%

Feasibility of interstitial stepping-source electronic brachytherapy to locally inoperable tumors

Ruder

Inghelram

Schneider

et al. 2020

jcb

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Purpose Radiotherapy is the mainstay in the treatment of locally inoperable tumors. Interstitial electronic needle-based kilovoltage brachytherapy (EBT) could be an economic alternative to high-dose-rate (HDR) brachytherapy or permanent seed implantation (PSI). In this work, we evaluated if locally inoperable tumors treated with PSI at our institution may be suitable for EBT. Material and methods A total of 10 post-interventional computed tomography (CT) scans of patients, who received PSI and simulated stepping-source EBT applied with Intrabeam system and needle applicator were used. EBT treatment planning software with 3-dimensional image and projection of applicator were applied for designing trajectories and establishing dwell positions. Dwell position doses were summarized, and doses covering 90% of the target volume (D 90 ) achieved with stepping-source EBT were compared to those of PSI. Additionally, conformality of dose distributions and total irradiation time were assessed using conformation number (CN) or conformal index (COIN). Results In all patients, D 90 of EBT exceeded the prescribed dose or D 90 of PSI on average by 4.7% or 21.3% relative to the prescribed dose, respectively. Mean number of trajectories was 5.0 for EBT and 6.9 for PSI. Average CN/COIN for EBT was 0.69, with a mean irradiation time of 27.8 minutes for standardized dose of 13 Gy. Conclusions Stepping-source EBT allowed for a conformal treatment of inoperable interstitial tumors with similar D 90 . Fewer trajectories were required for EBT in majority of cases.

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Head and neck cancer reirradiation with interstitial high‐dose‐rate brachytherapy

Abstract: Curative-intent HDR brachytherapy reirradiation can provide excellent local control and encouraging OS. Given the late toxicity rates, patient selection is essential, with particular utility for younger patients or those treated with salvage resection.

Cited by 16 publications

References 20 publications

Status of Treatment and Prophylaxis for Radiation-Induced Oral Mucositis in Patients With Head and Neck Cancer

Status of Treatment and Prophylaxis for Radiation-Induced Oral Mucositis in Patients With Head and Neck Cancer

A national surveillance study of the current status of reirradiation using brachytherapy in Japan

Feasibility of interstitial stepping-source electronic brachytherapy to locally inoperable tumors

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