Abstract
Purpose/ObjectivesTo establish the feasibility and safety of intraoperative placement of cesium-131 (Cs-131) seeds for re-irradiation in recurrent head and neck cancer (HNC).MethodsPatients with resectable recurrent HNC who were deemed to have a high risk of second recurrence were eligible. Immediately after tumor extirpation, seeds were implanted in the surgical bed based on the preoperative treatment plan with intraoperative adjustment. The surgical bed and the seeds were covered with a regional flap or microvascular free flap. A CT of the neck was obtained on postoperative day 1 for evaluation of the postoperative dose distribution. Patients were followed 1 and 3 months after surgery, then every 3 months in the first 2 years.ResultsFrom November 2016 to September 2018, 15 patients were recruited and 12 patients received treatment per protocol. For the patients who had implants, the sites of initial recurrence included 10 neck alone, 1 neck and larynx, and 1 neck/peristomal. The median follow-up was 21.4 months. After surgery, patients remained hospitalized for a median of 6 days. There were no high-grade toxicities except two patients with wound complications requiring wound care. Eight patients had recurrences, three locoregional alone, three distant alone, and two with both locoregional and distant recurrences. Only one patient had an in-field failure. Five patients died, with 1- and 2-year overall survival of 75 and 58%.ConclusionsCs-131 implant after surgical resection in recurrent HNC is feasible and safe. There were no unexpected severe toxicities. Most failures were out-of-field or distant.Clinical Trial Registration ClinicalTrials.gov, identifier NCT02794675.
Highlights
Head and neck cancers (HNC) represented an estimated 53,260 new diagnoses of malignancy in the United States in 2020, with 10,750 estimated deaths [1]
Depending on the site of recurrence, these toxicities may be prohibitive to re-irradiation with external beam radiotherapy (EBRT) techniques, when considered in conjunction with the increased risk of surgical complications such as wound dehiscence, tissue necrosis, or carotid blowout [6,7,8]
We report our preliminary experience using Cs-131 seed implantation as adjuvant treatment for patients with recurrence of their HNC who undergo salvage surgery
Summary
Head and neck cancers (HNC) represented an estimated 53,260 new diagnoses of malignancy in the United States in 2020, with 10,750 estimated deaths [1]. The primary treatment for recurrence of HNC is surgical resection if possible, often followed by adjuvant radiotherapy to the resection bed, especially for patients with high-risk features [3, 4]. Both of these treatments can be complicated by prior radiotherapy. In a meta-analysis of re-irradiation for recurrent or second primary HNC, 28% of over 3,700 patients across 39 studies underwent postoperative re-irradiation Their rates of grade 3+ acute and late toxicities were 32 and 29% respectively, with radionecrosis, dysphagia, and trismus among the most common grade 3–4 late toxicities [7]
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