Iodine‐125 Seed Implantation as an Adjunct to Surgery in Advanced Recurrent Squamous Cell Cancer of the Head and Neck

Abstract

Survival for extensive recurrent squamous cell carcinomas of the head and neck remains poor, with the major cause of death being local recurrence. Surgical implantation of iodine‐125 interstitial seeds allows tumoricidal doses of radiation to be delivered to residual tumor while minimizing radiation doses to the surrounding tissues. From 1978 to 1988, 39 implantations were performed on 35 patients for extensive recurrent squamous cell carcinoma of the head and neck. The decision for implantation was based on positive margins or close to resection margins from frozen sections after salvage resection. The determinate 5‐year disease‐free survival was 41%, with both the overall and no evidence of disease 5‐year survivals being 29%. Significant complications occurred in 36% of all cases. This figure increased to 56% when flap reconstruction was required. Possible reasons for this seemingly high complication rate are discussed. Considering the advanced nature of these recurrent carcinomas, surgical resection with iodine‐125 seed implantation appears to be an effective method of managing disease that might otherwise be judged unresectable and treated for palliation only.

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

“…The 5 y disease-free survival was found to be 41%, and 29% of the patients did not show any disease progression. 38 Ashamalla et al reported 94 patients who were treated with gold grain implants; the total radiation dose administered to the patients ranged from 40-120 Gy, with a median of 80 Gy. 39 Complete local tumor control was achieved in 33% cases, palliation was successfully accomplished in 76% cases, cessation of bleeding occurred in 50% cases, pain control was achieved in 88% cases and dysphagia was relieved in 60% cases.…”

“…[37][38][39] Martinez et al have reported an overall complication rate of 11% in 48 patients. 40 Goffinet et al reported that approximately half of their patients developed complications.…”

Perioperative high-dose-rate brachytherapy (PHDRB) in previously irradiated head and neck cancer: Initial results of a Phase I/II reirradiation study

“…In these studies, reirradiation was delivered by means of postoperative EBRT (22), postoperative chemoradiation (23,24), intraoperative electron beam radiotherapy (IOERT) (25,26), intraoperative high-dose rate brachytherapy (IOHDR) (27) and LDR (28)(29)(30)(31)(32), pulsed dose-rate (PDR) (33), or high-dose-rate (HDR) brachytherapy (34). Two-year survival rates higher than 50% have been reported in at least six of the studies referenced above (23-25, 28, 33).…”

CT-Guidance Interstitial 125iodine Seed Brachytherapy as a Salvage Therapy for Recurrent Spinal Primary Tumors

“…Pain relief in 24 h has been reported and the result was more than 90% [28][29][30]. For patients with relatively large scale vertebral destruction or a high incidence of fractures, PVP or PVP with radioactive seed brachytherapy is the preferred treatment [31]. In order to protect normal tissues for repeat irradiation spinal tumors, Memorial Sloan-Kettering Cancer Center was the first in the world who used HDR technique for spinal tumors [32].…”