Intraoperative radiotherapy for pre-irradiated head and neck cancer

Abstract

Background and purpose: Radiotherapy of recurrent head and neck tumours is limited in dose due to pre-treatment up to normal tissue tolerance doses. Surgery alone is limited by the problems related to pre-surgery, post-radiation fibrosis, and infiltration of tumours into nerves and vessels too closely to be completely removed. Our aim was to evaluate the possible role of intraoperative radiotherapy (IORT) in such tumours treated with palliative intent. Methods: In the last 10 years, we performed 113 intraoperative irradiations in a total of 84 pre-irradiated patients with head and neck cancer. The patient data were evaluated with regard to palliative effect, complications of treatment, recurrence and survival after IORT. Results: Palliation of symptoms, as assessed by clinical evaluation, was achieved in 88% of symptomatic patients, often just by removal of large exophytic or exulcerating tumours, with IORT preventing their immediate recurrence after surgery. The complication rate did not exceed that expected after surgery alone. The median survival after IORT was 6.8 months, with a median time to local tumour recurrence or progression of 3.7 months. Conclusion: Intraoperative irradiation can be used as a palliative treatment option in pre-treated head and neck tumours with satisfactory results. With large and infiltrating tumours, however, recurrences or tumour progression occur close to the IORT portals, thus rendering this method unsuitable for achieving long-term control in such extended tumours.