Iridium-192 Implants in the Treatment of Tonsillar Region Malignancies

Abstract

\s=b\A total of 127 patients with histologically proved diagnosis of carcinoma of the tonsillar region and soft palate were treated over the past ten years utilizing interstitial iridium-192 implants. Eighty patients were treated for primary tumors and 47 patients for either recurrent or persistent tumors after definitive irradiation and/or surgery. All patients with primary tumors were treated by a combination of external megavoltage irradiation and interstitial iridium-192 implants, whereas patients with recurrent tumors were treated by interstitial implants alone. In the primary group, 95% of patients with T1 and T2 lesions and 79% with T3 and T4 lesions achieved complete local tumor control. The three-year absolute disease-free survival rate was 72%.Seventy-five percent local tumor control was obtained in patients with recurrent disease, with two-year absolute disease\x=req-\ free survival of 42%. Treatment-related complications such as soft-tissue necrosis or osteoradionecrosis occurred in 6% of patients in the primary group and 23% in recurrent group. This treatment regimen offers an excellent locoregional control with no significant functional or esthetic impairment. Most patients with primary lesions who fail this regimen can be salvaged by surgery or reirradiation using interstitial implants. Reirradiation with interstitial implants is feasible and offers a good chance of long-term local tumor control in the selected group of patients with recurrent disease for whom external irradiation and/or surgery had not been successful. (Arch Otolaryngol 1985;111:812-815) External irradiation alone has proved efficacious in treating many early-stage head and neck can¬ cers. Several recent studies have reported long-term local tumor con¬ trol as high as 70% to 80% for Tl and T2 carcinoma of the tonsillar region using external irradiation alone. In contrast, irradiation alone in the treatment of locally advanced (T3 and T4) lesions has shown poor local con¬ trol, ie, 20% to 35%.'3 This is appar¬ ently due to the large tumor volume frequently associated with hypoxic radioresistant cell populations. Much higher doses of radiation are required to sterilize these tumors. Several investigators have recom¬ mended radiation doses of 6,000 to 6,500 rad over six to seven weeks for Tl and T2 lesions, and 7,000 to 8,000 rad over eight to nine weeks for T3 and T4 lesions.14 Despite higher doses of external irradiation, which often are associated with high morbidity, results obtained so far for locally advanced cancer of the tonsillar region are unsatisfactory. The surgi¬ cal salvage rate for these patients also remains quite poor. Adjuvant system¬ ic chemotherapy along with irradia¬ tion and/or surgery also has not shown appreciable improvement in

Wound Complications Associated With Brachytherapy for Primary or Salvage Treatment of Head and Neck Cancer

“…Also, the relatively small size of our study group augments the impact of any individual complication. The type and severity of wound complications noted in our group of 20 primary treatment patients are similar, however, to complications reported in other series 1,3,6‐10 . Nearly all wound complications in our primary group were mild to moderate in severity and involved infection or mucosal soft tissue necrosis that could be handled nonoperatively, although abscess drainage was required in four patients.…”

Loco-regional failures in head and neck cancer: can they be effectively salvaged by nonsurgical therapeutic modalities?

“…This uncertainty is partly due to the heterogeneous patient population, the selection of which could be influenced by a host of disease-and patient-related factors. 16,[19][20][21][22] Similarly, in the present series also, although a maximum of 50 Gy was delivered for salvage, there did not appear to be any correlation with the salvage RT dose or cumulative RT doses and the grade of reaction (Table 8). This might influence decision-making for both the patient and the clinician.…”

Efficacy, outcomes, and complication rates of different surgical and nonsurgical treatment modalities for recurrent/residual oropharyngeal carcinoma: A systematic review and meta‐analysis

“…Twenty‐two articles were selected for inclusion and analysis in the study (Table ) . The studies reported on 1105 patients, a mean of 50 patients (range, 5–163) per study, published between 1976 and 2014.…”

“…We could not include a few large studies of mixed head and neck sites because it was not possible to extract or obtain oropharyngeal specific survival data separate to other data . Some of the studies included in the qualitative analysis could not be included in the meta‐analysis because of absence of either 3‐year or 5‐year OS data . Furthermore, reported prognostic data were limited and disparate and could not be subjected to meta‐analysis.…”