Can interstitial high dose rate brachytherapy combined or not combined with external beam radiotherapy compensate surgical resections with microscopic positive margins?

Abstract

6078 Background: The literature is scarce regarding the use of interstitial high dose rate brachytherapy (I-HDR) as salvage therapy in head and neck cancer (HNC). The best approach for isolated cervical recurrences is controversial, although surgery is mandatory when feasible. We evaluated the long-term results of a treatment policy combining salvage surgery and interstitial high dose rate brachytherapy (I-HDR) for cervical recurrences of HNC. Methods: Patients with recurrent cervical cancer with primary origin in the head and neck who were submitted to salvage surgery also had, at the time of operation, an interstitial implant of catheters for brachytherapy. Results: Charts of 21 patients treated with surgery combined to I-HDR between 1994 and 2004, with or without external beam radiotherapy were reviewed. The crude local control rate for all patients was 52.4%. The 8- and 10-year overall (OS) and local relapse-free survival (LRFS) rates were, 42.9%, 42.5%, 28.6% and 27%, respectively. The only predictive factor associated to LFRS and OS was negative margin status (p = 0.0007 and p = 0.0002). Conclusions: We conclude that complete surgery is mandatory for long term control. The doses given by brachytherapy are not high enough to compensate for microscopic residual disease after surgery. Studies and strategies involving the use of concurrent chemotherapy and new drugs are still necessary. No significant financial relationships to disclose.