Perioperative HDR Brachytherapy for Reirradiation in Head and Neck Recurrences: Single-institution Experience and Systematic Review

Abstract

IMBT could play an important role in the retreatment of recurrent head and neck cancer.

HDR interventional radiotherapy (brachytherapy) in the treatment of primary and recurrent head and neck malignancies

“…However, even if it has become clear that brachytherapy may also be used in recurrences, especially in already irradiated fields, its specific value in many clinical situations and in particular in the tricky post‐EB recurrent setting is not yet fully exploited. Our previous studies and the survival figures for the recurrences in the present study (eg, 52% 3‐year, 28% 5‐year DSS; see Figure ) demonstrate a certain rate of long‐term survivors and even of cure in clinical situations often considered inoperable, as post‐EB recurrences, with very low toxicity deriving from the reirradiation . In particular, groups I, II, and III discussed below are mostly made up of recurrences for which IRT offers specific advantages according to the disease site and the clinical situations.…”

“…This fact, and the substantial absence of severe toxicities from IRT as an exclusive and perioperative treatment, makes it a very useful tool in head and neck oncology. However, IRT remains widely underexploited in daily clinical practice as an exclusive and perioperative treatment, even if it is probably the safest reirradiation modality . This is also because IRT is a multidisciplinary tool at the border between surgery and radiotherapy, and close cooperation between surgeons and radiation oncologists during every phase, from the recommendation of treatment in the tumor board to the implantation in the operating theater and to the prescription and dose painting at the radiotherapy department, is necessary to perform high‐quality IRT.…”

“…All of these cases, except two, were recurrences, and all of these cases, except two, had already been irradiated with EBs, but an adjuvant treatment after salvage surgery was considered to be rational and potentially useful. Surgery was most often performed through an endoscopic approach, and the implantation in these cases was performed at the end of surgical resection under endoscopic guidance (endoscopy‐guided brachytherapy, EGBRT) (group II, 15 patients; Figure C,D). Perioperative interstitial IRT for neck recurrence of a malignancy that was already irradiated with EBs, when an adjuvant treatment was considered to be rational and potentially useful after salvage surgery, also because of the extracapsular spread. The plastic tubes were always placed at the end of surgical resection and before flap insetting when reconstruction was performed (group III, 13 patients; Figure E,F). Exclusive interstitial IRT for a midface malignancy (primary, 23; recurrent, 6) for which surgical reconstruction was not expected to be fully satisfactory.…”

“…Surgery was most often performed through an endoscopic approach, and the implantation in these cases was performed at the end of surgical resection under endoscopic guidance (endoscopy‐guided brachytherapy, EGBRT) (group II, 15 patients; Figure C,D). Perioperative interstitial IRT for neck recurrence of a malignancy that was already irradiated with EBs, when an adjuvant treatment was considered to be rational and potentially useful after salvage surgery, also because of the extracapsular spread. The plastic tubes were always placed at the end of surgical resection and before flap insetting when reconstruction was performed (group III, 13 patients; Figure E,F). Exclusive interstitial IRT for a midface malignancy (primary, 23; recurrent, 6) for which surgical reconstruction was not expected to be fully satisfactory. For midface malignancy, we intend lesions arising at the junction between mucosal and skin surfaces, and typically at the level of the lips, cheek, and nose vestibule (group IV, 29 patients; Figure G,H).…”

“…Plastic tubes were always placed in the operating room in the presence of the surgeons and radiation oncologists under general anesthesia in all except four cases (three inferior lips and a cheek) in which implants were placed under local anesthesia, because of anesthesiology concerns. Flexible Implant 6F Tubes were inserted, spaced 0.8‐1.2 cm apart, using guide channels that were previously placed with a needle and fixed by buttons sutured to the skin and other technical tricks when needed, as previously described . The exact configuration and number of catheters were always tailored to the extent, depth, and shape of the target volume.…”