Abstract
BackgroundThe purpose of this study is to review our experience with the use of IORT for patients with advanced cervical metastasis.MethodsBetween August 1982 and July 2007, 231 patients underwent neck dissections as part of initial therapy or as salvage treatment for advanced cervical node metastases resulting from head and neck malignancies. IORT was administered as a single fraction to a dose of 15 Gy or 20 Gy in most pts. The majority was treated with 5 MeV electrons (112 pts, 50.5%).Results1, 3, and 5 years overall survival (OS) after surgery + IORT was 58%, 34%, and 26%, respectively. Recurrence-free survival (RFS) at 1, 3, and 5 years was 66%, 55%, and 49%, respectively. Disease recurrence was documented in 83 (42.8%) pts. The majority of recurrences were regional (38 pts), as compared to local recurrence in 20 pts and distant failures in 25 pts. There were no perioperative fatalities.ConclusionsIORT results in effective local disease control at acceptable levels of toxicity. Our results support the initiation of a phase III trial comparing outcomes for patients with cervical metastasis treated with or without IORT.
Highlights
The purpose of this study is to review our experience with the use of IORT for patients with advanced cervical metastasis
Intraoperative radiation therapy has been available to select head and neck cancer patients presenting to our group since the 1980s [3,4]
Study population Between August 1982 and July 2007, 231 patients were treated with surgery and IORT for advanced cervical node metastases from head and neck cancers as part of initial treatment or for recurrent disease
Summary
The purpose of this study is to review our experience with the use of IORT for patients with advanced cervical metastasis. The management of advanced or recurrent cervical node metastases poses a challenge for surgeons and radiation oncologists. Prior surgery and radiation therapy can induce tissue fibrosis. Intraoperative radiation therapy has been available to select head and neck cancer patients presenting to our group since the 1980s [3,4]. IORT has been offered to those patients who have metastatic nodal disease recurrent or persistent after prior surgery and/or radiation treatment or who have nodal disease at initial presentation which in the judgment of the surgeon has a significant chance of having gross or residual microscopic cancer persistent at the conclusion of the surgery. The method of radiation at the time of surgery allows for effective shielding and retraction of critical structures such as the cervicofacial skin, laryngopharynx, and mandible, while allowing for maximal exposure of the tumor bed to the radiation beam
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