Intra-Operative Radiotherapy – 5 Years of Experience in the Palliative Treatment of Recurrent and Advanced Head and Neck Cancers

Abstract

Recurrent and advanced cancer in the head and neck region is usually associated with limited therapeutic concepts and a dismal prognosis. Efforts mainly focus on palliative treatment in order to improve the patient’s quality of life. From May 1989 to December 1994, a total of 120 intra-operative radiotherapy (IORT) procedures with high-energy electron beams (mean energy: 7 MeV; mean dose: 20 Gy) were performed in 95 patients. Therapy was usually performed under endotracheal anaesthesia (84%). There were 91 cases (75.8%) of recurrence in the lymph nodes of the neck and 14 cases (11.7%) of local recurrence. 15 patients (12.5%) received IORT as part of the initial treatment. Considering the palliative nature of IORT in these patients, only an R2 resection (gross residual tumour) was achieved in 71.7%. Local tumour control was nonetheless possible in 17% (R2 resection) to 64% (complete Ro resection), with a mean 11-month follow-up period for survivors (mean for deceased patients: 8 months). Regarding palliative criteria, IORT proved to be feasible since patients profited from short hospitalisation (median: 10 days), a low complication rate (27 instances; e.g. tracheostomy: 11; necrosis: 8, or fistula: 3) and, in part, a substantial reduction of pain (73.8%). Most of them regained physical and psychic integrity for weeks to months and were able to take part in social life during the final stage of their disease.

Intraoperative radiation therapy (IORT) in head and neck cancer

“…Concurrently, Spaeth et al [ 33 ] evaluated the palliative efficacy of IORT treatment from May 1989 to December 1994, in a total of 120 sites in 95 patients predominantly suffering from recurrence in lymph nodes (75.8%) and primary site (11.7%). To a lesser extent, IORT constituted part of the initial treatment (12.5%).…”

“…However, long-term survival rates do not seem to conform in all series. [ 26 , 31 , 33 , 34 , 36 – 38 ]…”

Recurrent salivary gland carcinomas treated by surgery with or without intraoperative radiation therapy

“…This visualization allows treatment with radiation even after prior delivery of full courses of radiation therapy. Although we did not analyze the incidence of treatment‐related complications in the present series, others have demonstrated that IORT is well tolerated for the treatment of head and neck cancers and does not increase perioperative morbidity or mortality 29–31…”

Feasibility of Flap Reconstruction in Conjunction With Intraoperative Radiation Therapy for Advanced and Recurrent Head and Neck Cancer

“…Locoregional control using IORT for recurrent head and neck cancer has been reported by a number of groups 4,6–8 . Adequate palliation and local control is not generally achieved with IORT when gross residual disease remains in situ, although some short‐term benefit may exist 9 . IORT has the greatest benefit for patients in whom clear or close microscopic margins are surgically obtained 6 .…”

“…4,6 -8 Adequate palliation and local control is not generally achieved with IORT when gross residual disease remains in situ, although some short-term benefit may exist. 9 IORT has the greatest benefit for patients in whom clear or close microscopic margins are surgically obtained. 6 Assessing IORT-related morbidity is challenging when considering the heterogeneity of the patients treated and the aggressive prior therapy many have already received.…”