Intraoperative I-125 seed implantation for extensive recurrent head and neck carcinomas.

Abstract

From 1978 to 1988, 41 patients with extensive recurrent carcinomas of the head and neck were treated with surgical resection plus intraoperative iodine-125 seed implantation. Surgery was performed to resect the tumors and to expose the tumor beds for implantation. I-125 seeds were implanted intraoperatively, with a spacing of 0.75-1 cm between adjacent seeds, either into the soft tissue in the tumor bed or onto small patches of gelatin sponges to cover the bone, nerve, or blood vessel involved with disease. Reconstructive flaps were used in 18 patients. The average I-125 dose delivered by the implanted seeds was 8,263 cGy. The determinate 5-year actuarial survival rate for the entire group was 40%. The 5-year local disease control rate was 44%. Major complications were transient wound infection (32%), flap necrosis (24%), fistula formation (10%), and carotid blowout (5%). These results indicate that surgical resection plus I-125 seed implantation provides a potentially curative treatment for patients with extensive recurrent head and neck carcinomas that would be considered traditionally unresectable and that would be treated only with palliative therapy.

Percutaneous computed tomography/ultrasonography-guided permanent iodine-125 implantation as salvage therapy for recurrent squamous cell cancers of head and neck

“…9 Interstitial permanent brachytherapy addresses this problem by delivering a high dose of radiation directly to the tumors while ensuring that a lower dose is delivered to the adjacent normal organs. [10][11][12] Objective: To assess the feasibility, efficacy and morbidity of permanent percutaneous 125 i seed implantation under computed tomography (CT)/ultrasonography guidance for recurrent squamous cell carcinomas of head and neck.…”

Role of Perioperative Brachytherapy in the Treatment of Malignancies Involving the Skull Base and Orbit

“…Iodine-125, Iridium-192, Au-198, Radon-222, and Radium-226 represent some of them. Although there have been several groups in the 80s reporting on implant BT by seeds or grains in head and neck cancers, [39][40][41][42][43] the number of evolving publications including skull base cases remained very low. Intraoperative implantation of Iodine-125 seeds for the treatment of both extensive primary and recurrent head and neck carcinomas had been increasingly reported in the 80s.…”

“…Intraoperative implantation of Iodine-125 seeds for the treatment of both extensive primary and recurrent head and neck carcinomas had been increasingly reported in the 80s. [39][40][41][42][43] The rationale was to use implantation BT as adjuvant treatment in recurrent, previously irradiated and resected head and neck carcinomas. Common complications were infections, flap necrosis, poor wound healing, fistula formation, carotid blowout (if the tumor was adjacent to carotid artery), and osteoradionecrosis.…”

“…Common complications were infections, flap necrosis, poor wound healing, fistula formation, carotid blowout (if the tumor was adjacent to carotid artery), and osteoradionecrosis. 40 Iodine-125 has been widely used type of radionuclide for seed implantation. It has been preferred because it is characterized by the low energy of the emitted photons (27 to 35 keV) and the fact that medical personnel can be easily protected.…”

CT-guided iodine-125 seed permanent implantation for recurrent head and neck cancers

“…A variety of isotopes are available for use as HDR or LDR temporary interstitial brachytherapy, but the most commonly used isotope is Iridium-192, Co-60 or Cs-137 et al, especially for treating recurrent solid cancers [8-10]. However, the use of those isotopes for intraoperative HDR brachytherapy requires very complicated shielding [11]. …”