Intraoperative radiation therapy for advanced cervical metastasis: a single institution experience

Abstract

BackgroundThe purpose of this study is to review our experience with the use of IORT for patients with advanced cervical metastasis.MethodsBetween August 1982 and July 2007, 231 patients underwent neck dissections as part of initial therapy or as salvage treatment for advanced cervical node metastases resulting from head and neck malignancies. IORT was administered as a single fraction to a dose of 15 Gy or 20 Gy in most pts. The majority was treated with 5 MeV electrons (112 pts, 50.5%).Results1, 3, and 5 years overall survival (OS) after surgery + IORT was 58%, 34%, and 26%, respectively. Recurrence-free survival (RFS) at 1, 3, and 5 years was 66%, 55%, and 49%, respectively. Disease recurrence was documented in 83 (42.8%) pts. The majority of recurrences were regional (38 pts), as compared to local recurrence in 20 pts and distant failures in 25 pts. There were no perioperative fatalities.ConclusionsIORT results in effective local disease control at acceptable levels of toxicity. Our results support the initiation of a phase III trial comparing outcomes for patients with cervical metastasis treated with or without IORT.

Intraoperative Radiation Therapy: A Promising Treatment Modality in Head and Neck Cancer

“…We previously reported one of the largest retrospective series on neck IORT (12); it included 231 patients with advanced cervical metastasis, 88% (198 patients) had recurrent tumors. All included patients had either microscopic or gross residual disease.…”

“…Early studies by Toita et al reported a significant increase in the rate of toxicities with doses exceeding 20 Gy (19), whereas other studies failed to show significant changes in toxicity rates with different doses (10, 12). Of the several reported complications, carotid artery rupture incidence ranged between 2 and 5% (3, 13, 18) and up to 10% in older series (19).…”

“…Also, it is well established that ischemic tumor areas may be more resistant to radiation treatment due to the paucity of oxygen fixing DNA damage caused by free radicals, and thus, a single high IORT dose does not provide ample time for tumor re-oxygenation. However, it is quite likely that the effect of this unfavorable ischemic milieu is counterbalanced by the single high IORT dose, when compared to standard external beam fractionation (12, 31). Moreover, there is evidence to suggest that high dosage of radiation in a single fraction can eradicate cancer stem cells that would have been radioresistant at standard fractionation and has even been theorized to have implications in unleashing favorable immune responses such as the abscopal effect (32, 33).…”

Интраоперационная Лучевая Терапия: Реальность И Перспектива

“…Опубликованы результаты свыше двадцати рандоми-зированных исследований, в которых показано, что при-менение ИОЛТ у пациентов со злокачественными ново-образованиями различных локализаций в области головы и шеи приводит к улучшению локорегионарного контроля без повышения токсичности [15][16][17][18][19][20][21][22][23][24]. Авторы заключают, что ИОЛТ, используемый в дозах менее 20 Гр, безопасен при лечении рака головы и шеи даже у ранее облученных пациентов.…”

“…Это может быть полезно в случаях прогрес-сирования, особенно у больных опухолями, поражающи-ми основание черепа, где микроскопическая остаточная опухоль вероятна даже после «полной» хирургической резекции [15]. Тем не менее дальнейшие исследования необходимы для определения идеальной дозы и других факторов, способствующих минимизации частоты ослож-нений [23,24].…”