Efficacy and Safety of CT-Guided 125I Seed Implantation As a Salvage Treatment for Locally Recurrent Head and Neck Soft Tissue Sarcoma after Surgery and External Beam Radiotherapy: A 12-Year Study at a Single Institution

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The treatment for locally recurrent head and neck soft tissue sarcoma (HNSTS) after failure of previous surgery and external beam radiotherapy (EBRT) remains a problematic challenge without widely accepted recommendations. We aimed to evaluate the efficacy and safety of CT-guided radioactive 125I seed (RIS) implantation for the treatment of locally recurrent HNSTS after surgery and EBRT and analyze the prognostic factors of efficacy. Between December 2006 and February 2018, 25 patients with locally recurrent HNSTS after failure of surgery and EBRT were erolled. We re-staged the recurrent tumors according to the American Joint Committee On Cancer (AJCC) System for soft tissue sarcoma of the head and neck sarcoma (8th ed, 2017) when analyzing the data. All these patients successfully underwent treatment with computed tomography (CT)-guided 125I seed implantation. The postoperative evaluation of seed and dose distribution was performed immediately after surgery. The primary endpoints included the objective overall response rate (ORR) and local progression-free survival (LPFS), and the secondary endpoints were overall survival (OS) and safety profiles. Following 125I seed implantation brachytherapy, the ORR was 72.0%, median LPFS was 16.0 months and median OS was 28.0 months. Furthermore, the 1-, 2-, 3-, 4- and 5-year LPFS rates were 65.6%, 48.1%, 34.4%, 22.9%, and 22.9% respectively and the 1-, 2-, 3-, 4- and 5-year survival rates were 70.8%, 56.9%, 46.6%, 40.8%, and 34.0%, respectively. Multivariate analyses showed that the recurrent T stage (T4 vs ≤ T3；hazard ratio [HR]= 4.020; 95% confidence interval [CI]= 1.117-14.466; P=0.033) and histological grade (G3 vs ≤ G2；HR= 3.260; 95% CI= 1.031-10.306; P=0.044) were independent prognostic factors of LPFS, whereas only the histological grade (G3 vs ≤ G2；HR= 3.230; 95% CI=1.061-9.834; P=0.039) was an independent predictor of OS. The major adverse events were skin/mucosal toxicities, which were generally of lower grade (≤ grade 2) and well tolerated. RIS implantation could be an effective and safe alternative treatment for locally recurrent HNSTS after failure of surgery and EBRT. Recurrent T stage and histological grade were the main factors influencing the efficacy.