High-dose-rate intraoperative brachytherapy and radical surgical resection in the management of recurrent head-and-neck cancer
| Autor: | Gil'ad N. Cohen, Nancy Y. Lee, Richard J. Wong, Suzanne L. Wolden, Michael J. Zelefsky, Ian Ganly, Sewit Teckie, Felix Ho, Johnny Chiu, L. Matthew Scala |
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| Rok vydání: | 2013 |
| Předmět: |
Adult
Male medicine.medical_specialty Adolescent medicine.medical_treatment Brachytherapy Disease-Free Survival Intraoperative Period Young Adult medicine Humans Whole Body Imaging Radiology Nuclear Medicine and imaging Child Intraoperative radiation therapy Aged Retrospective Studies Aged 80 and over Squamous Cell Carcinoma of Head and Neck business.industry Hazard ratio Head and neck cancer Cancer Radiotherapy Dosage Retrospective cohort study Middle Aged Prognosis medicine.disease Magnetic Resonance Imaging Surgery Radiation therapy Oncology Head and Neck Neoplasms Child Preschool Positron-Emission Tomography Carcinoma Squamous Cell Female Radiotherapy Adjuvant Neoplasm Recurrence Local Tomography X-Ray Computed business Follow-Up Studies |
| Zdroj: | Brachytherapy. 12:228-234 |
| ISSN: | 1538-4721 |
| DOI: | 10.1016/j.brachy.2013.01.165 |
| Popis: | Purpose To report long-term outcomes of high-dose-rate (HDR) intraoperative radiotherapy (IORT) at the time of radical resection for recurrent head-and-neck cancer and determine potential prognostic factors. Methods and Materials Between 7/1998 and 11/2011, 57 patients with recurrent head-and-neck cancer underwent radical resection with curative intent and single-fraction IORT to 59 sites using a Harrison-Anderson-Mick applicator with remotely after-loaded 192Ir HDR brachytherapy. Results One- and 3-year in-field progression-free survival (IFPFS) was 67% and 57%, respectively. In a multivariate model, IORT dose >15 Gy (hazard ratio [HR] = 0.11; p = 0.02), and prerecurrence disease-free interval >12 months (HR = 0.29; p = 0.04) independently predicted for superior IFPFS; nodal extracapsular extension (HR = 4.62; p = 0.003) predicted for inferior IFPFS. Three-year overall survival (OS) was 50% vs. 32% in those achieving in-field control vs. those not achieving in-field control (p = 0.04). Grade 3+ toxicity occurred in 37% and was unrelated to IORT dose. Conclusions HDR-IORT combined with radical surgical resection is associated with durable IFPFS and long-term overall survival in select patients with acceptable treatment-related morbidity. IORT dose >15 Gy should be used to increase the likelihood of disease control. The ability to achieve in-field local control in this poor prognostic cohort was associated with improved survival outcomes. |
| Databáze: | OpenAIRE |
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