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Reirradiation for recurrent head and neck cancer with salvage interstitial pulsed-dose-rate brachytherapy

Long-term results

Re-Bestrahlung bei rezidivierenden HNO-Tumoren mit interstitieller Salvage Pulsed-dose-rate-Brachytherapie

Langzeitergebnisse

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Abstract

Purpose

To assess the long-term results of protocol-based interstitial pulsed-dose-rate (PDR) brachytherapy as reirradiation combined with simultaneous chemotherapy and interstitial hyperthermia in selected patients with recurrent head and neck tumors.

Materials and methods

A total of 104 patients with biopsy-proven recurrent head and neck cancer were treated with interstitial PDR brachytherapy. Salvage surgery had also been undergone by 53/104 (51 %) patients (R1 or R2 resection in > 80 % of patients). Salvage brachytherapy alone was administered in 81 patients (78 %), with a median total dose of 56.7 Gy. Salvage brachytherapy in combination with external beam radiotherapy (EBRT) was performed in 23/104 patients (32 %), using a median total dose of DREF = 24 Gy. Simultaneously to PDR brachytherapy, concomitant chemotherapy was administered in 58/104 (55.8 %) patients. A single session of interstitial hyperthermia was also used to treat 33/104 (31.7 %) patients. The analysis was performed after a median follow-up of 60 months.

Results

Calculated according to Kaplan–Meier, local tumor control rates after 2, 5, and 10 years were 92.5, 82.4, and 58.9 %, respectively. Comparing results of salvage PDR brachytherapy with or without simultaneous chemotherapy, the 10-year local control rates were 76 vs. 39 % (p= 0014), respectively. No other patient- or treatment-related parameters had a significant influence on treatment results. Soft tissue necrosis or bone necrosis developed in 18/104 (17.3 %) and 11/104 (9.6 %) patients, respectively, but only 3 % of patients required surgical treatment.

Conclusion

PDR interstitial brachytherapy with simultaneous chemotherapy is a very effective and, in experienced hands, also a safe treatment modality in selected patients with head and neck cancer in previously irradiated areas.

Zusammenfassung

Hintergrund und Ziel

Es erfolgte die Analyse der Langzeitergebnisse einer protokollbasierten interstitiellen Brachytherapie (Re-Bestrahlung) mit simultaner Chemotherapie und interstitieller Hyperthermie bei selektierten Patienten mit HNO-Rezidivtumoren.

Patienten und Methoden

Insgesamt wurden 104 Patienten mit histologisch gesichertem Rezidiv eines HNO-Karzinoms mit einer interstitiellen PDR („pulsed-dose-rate“)-Brachytherapie behandelt: 53/104 (51 %) Patienten unterzogen sich auch einer Salvage-Chirurgie (bei > 80 % der Patienten R1/R2-Resektion); 81 Patienten (78 %) wurden mit einer alleinigen Salvage-Brachytherapie bis zu einer Gesamtreferenzdosis von 56,7 Gy (Median) behandelt. Eine Salvage-Brachytherapie in Kombination mit einer perkutanen Strahlentherapie wurde bei 23/104 Patienten (32 %) mit einer Gesamtreferenzdosis in Höhe von Dref=24 Gy durchgeführt. Eine simultane Chemotherapie wurde bei 58/104 (55,8 %) Patienten verabreicht; 33/104 (31,7 %) Patienten wurden ergänzend mit einer interstitiellen Hyperthermie behandelt. Die Analyse wurde nach einem Follow-up im Median von 60 Monaten durchgeführt.

Ergebnisse

Die lokalen Tumorkontrollraten nach Kaplan-Meier lagen nach 2, 5 und 10 Jahren bei 92,5, 82,4 und 58,9 %. Im Vergleich der Ergebnisse der Salvage-PDR-Brachytherapie mit oder ohne simultaner Chemotherapie waren die lokalen 10-Jahres-Tumorkontrollraten bei 76 vs. 39 % (p= 0014). Keine anderen patientenbezogenen oder therapiebezogenen Parameter hatten einen signifikanten Einfluss auf die Therapieergebnisse. Bei 18/104 (17,3 %) und 11/104 (9,6 %) Patienten haben wir Weichteil- oder Osteoradionekrosen beobachtet, allerdings war nur bei 3 % der Patienten auch eine chirurgische Therapie erforderlich.

Schlussfolgerung

Die PDR-interstitielle Brachytherapie mit einer simultanen Chemotherapie ist eine sehr effektive und in erfahrenen Händen auch eine sichere Behandlungsmodalität für selektierte Patienten mit HNO-Rezidivtumoren in bereits bestrahlten Arealen.

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Authors and Affiliations

  1. Dept. of Radiation Oncology, University Hospital Erlangen, Universitätsstr. 27, 91052, Erlangen, Germany

    Vratislav Strnad,  Michael Lotter, Stephan Kreppner &  Rainer Fietkau

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  1. Vratislav Strnad
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  2. Michael Lotter
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Correspondence to Vratislav Strnad.

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V. Strnad, M. Lotter, S. Kreppner, and R. Fietkau state that there are no conflicts of interest. All studies on humans described in the present manuscript were carried out with the approval of the responsible ethics committee and in accordance with national law and the Helsinki Declaration of 1975 (in its current, revised form). Informed consent was obtained from all patients included in studies.

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Strnad, V., Lotter, M., Kreppner, S. et al. Reirradiation for recurrent head and neck cancer with salvage interstitial pulsed-dose-rate brachytherapy. Strahlenther Onkol 191, 495–500 (2015). https://doi.org/10.1007/s00066-014-0809-8

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  • DOI: https://doi.org/10.1007/s00066-014-0809-8

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