Intraoperative Radiation Therapy: A Promising Treatment Modality in Head and Neck Cancer.

Lara Hilal,Jean-Pierre Obeid,Fady Geara,Bassem Youssef,Karine A Al Feghali,Paul Ramia,Wassim Jalbout,Ibrahim Abu Gheida,Youssef H Zeidan

doi:10.3389/fonc.2017.00148

Abstract

Every year, almost 62,000 are diagnosed with a head and neck cancer (HNC) and 13,000 will succumb to their disease. In the primary setting, intraoperative radiation therapy (IORT) can be used as a boost in select patients in order to optimize local control. Addition of external beam radiation to limited volumes results in improved disease control over surgery and IORT alone. In the recurrent setting, IORT can improve outcomes from salvage surgery especially in patients previously treated with external beam radiation. The use of IORT remains limited to select institutions with various modalities being currently employed including orthovoltage, electrons, and high-dose rate brachytherapy. Practically, execution of IORT requires a coordinated effort and careful planning by a multidisciplinary team involving the head and neck surgeon, radiation oncologist, and physicist. The current review summarizes common uses, outcomes, toxicities, and technical aspects of IORT in HNC patients.

Highlights

Head and neck cancers (HNCs) continue to take a high toll with an estimated incidence of around 62,000 new cases in the United States in 2016 (1)
We previously reported one of the largest retrospective series on neck intraoperative radiation therapy (IORT) (12); it included 231 patients with advanced cervical metastasis, 88% (198 patients) had recurrent tumors
We reported on 46 patients with recurrent parotid tumors treated by [15,16,17,18,19,20] Gy Intraoperative electron radiation therapy (IOERT) in addition to external beam radiation therapy (EBRT) in 54% and chemotherapy in 19%

Summary

INTRODUCTION

Head and neck cancers (HNCs) continue to take a high toll with an estimated incidence of around 62,000 new cases in the United States in 2016 (1). Two forms of IORT have been studied for HNCs: high-dose rate (HDR) brachytherapy (6) and external beam that includes electrons and orthovoltage photons IORT (3, 4) The purpose of this manuscript is to review experience over the past four decades with the use of IORT in patients with primary or recurrent cancer of head and neck. Another study on neck IORT included 52 patients with recurrent tumors who received a median dose of 20 Gy of IOERT. An earlier series by Nag et al reported less favorable outcomes as compared to other listed studies It included 38 patients, 29% of which were treated with IOERT for primary site recurrence. Patients with neck metastasis who had no PNI, no LVSI, and no involvement of the carotid artery were reported to have better OS after IORT (12) Taken together, these results underscore the prognostic importance of surgical pathology details in addition to treatment dose in this patient cohort. Comp.: 16%, orocutaneous fistula: 5%, fatal fistula, wound or tracheal dehiscence and carotid occlusion: 2.6% each Comp.: 10%

20 Gy: NR

Findings

CONCLUSION