Simultaneous Interstitial Radiotherapy With Regional or Free-Flap Reconstruction, Following Salvage Surgery of Recurrent Head and Neck Carcinoma: Analysis of Complications

Combination of surgical resection and HDR-brachytherapy in patients with recurrent or advanced head and neck carcinomas

“…Generally, we followed the concept that the coverage of critical structures with well-vascularized tissue of microvascular or pedicled flaps reduces the danger of wound breakdown, which is supported by several authors (Stafford and Dearnaley, 1988;Quon and Harrison, 2002). Moscoso et al (1994) were the first to examine the use of microvascular free flaps for coverage of brachytherapy sites, and found a 20% decrease in the acute complication rate after free flap reconstruction. In the patient with the carotid ''blowout'', a radial forearm flap had been used for reconstruction of a tongue/floor of mouth defect whereas the carotid region was only covered by the cervical skin flap.…”

“…Other authors also state that insufficient wound coverage is a major contributing factor to the development of post-brachytherapy complications. This point is presumably more important than radiotherapeutic parameters like total cumulative dose, re-treatment dose, dose rate or dose volume (Moscoso et al, 1994).…”

High-dose-rate interstitial brachytherapy in recurrent and previously irradiated head and neck cancers—Preliminary results

“…Its main advantage over external beam radiation therapy derives from its enhanced conformality and rapid dose fall off, thus delivering biologically higher doses to the tumor while reducing dose to adjacent normal structures (7). However, some of the concerns of this approach include the need for hospitalization, radiation safety issues, and limitations of conventional dosimetry to minimize the normal tissue from receiving high radiation doses (8).…”

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).…”