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Purpose: High-dose-rate (HDR) interstitial brachytherapy has an established role in head and neck malignancies and offers good survival rates; however, there is scant data on improved local control (LC) and treatment-related complications in recurrent cases. We present our results in patients with recurrent head and neck cancers treated with HDR interstitial brachytherapy. Material and methods: Twenty-five patients with recurrent head and neck cancers were treated with HDR interstitial brachytherapy using Iridium 192 between 2009 and 2016. Of these, 75% received radical brachytherapy, and 25% received external beam radiation therapy (EBRT) followed by brachytherapy boost. Treatment sites included oral cavity (15/25) and oropharynx (10/25). Median dose of 4.5 Gy was administered twice per day, with median total brachytherapy dose of 40.5 Gy in radical and 27 Gy for EBRT cases. Results: With median follow-up of 25 months, 4 local recurrences were observed within first year of follow-up. Two-year local control and overall survival outcomes for the entire group were 75% and 68%, respectively. Local control rate with radical BRT vs. BRT as a boost following EBRT was found to be significant (2-year LCR 62% vs. 85%; p < 0.02). Dosimetric assessment revealed D90 - 4.08 Gy, V100 - 94.1%, V150 - 24.7%, and V200 - 10.1%. Xerostomia, altered taste, and dysphagia were the major complications commonly grade 1 and 2. Grade 3 toxicity was only 2%. Pre-treatment volume > 85 cc had a negative impact on overall survival (26 months vs. 12 months; p = 0.02), and interval time between primary and recurrence more than 15 months had an impact on the local control rate (p < 0.01). Conclusions: Results of HDR interstitial brachytherapy have shown acceptable local control and overall survival rates along with tolerable toxicities and morbidity in recurrent head and neck cancers. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the treatment outcomes with high-dose-rate (HDR) interstitial brachytherapy (HDR-BRT) in head and neck cancers (HNC). Material and methods: Fifty-eight patients with HNC as per American Joint Committee on Cancer (AJCC) TNM staging criteria were analyzed retrospectively between 2008 and 2015. Forty-two patients received external beam radiotherapy (EBRT) with HDR-BRT and 16 patients received BRT alone. The survival was calculated with respect to median biological equivalent doses (BED) and median 2 Gy equivalent dose (EQD2), keeping α/β = 10 for tumor. Loco-regional control and disease free survival was assessed. Results: The median follow-up period was 25 months (2-84 months). The disease-free survival (DFS) probability at year 1 was 82.7%, and 68% at year 7. The overall survival probability was 91.3% at year 1 and 85.8% at year 7. The local control rate was 70%. The rate of recurrence was 30%. Distant metastasis rate was 17.2%. The median BED and EQD2, respectively, were 86.78 Gy and 71.6 Gy. The DFS was 74.1% and 75.9% in patients receiving a dose more than median BED and EQD2, respectively, and was 64.8% and 61.5% for less than the median dose. Conclusions: The overall outcome was good with implementation of HDR-BRT used alone or as boost, and shows DFS as better when the dose received is more than the median BED and median EQD2. The role of HDR-BRT in HNC is a proven, effective, and safe treatment method with excellent long term outcome as seen in this study, which reflects the need for reviving the forgotten art and science of interstitial brachytherapy in HNC. [ABSTRACT FROM AUTHOR]

High Dose Rate (HDR) Interstitial Brachytherapy has an established role in head and neck malignancies and offers good survival rates, however, there are scant data on improved local control (LC) and treatment-related complications in patients with recurrent head and neck (H&N) cancers. We report our results in patients with recurrent H&N cancers treated with interstitial HDRBT. Methods and materials Twenty patients with recurrent H&N cancers were treated with HDR interstitial brachytherapy between January 2010 and December 2016. Of these, 75% received radical brachytherapy and 25% received external beam radiation therapy (EBRT) followed by brachytherapy boost. The treatment sites were oral cavity (12/20) and oropharynx (8/20). The median dose was 4.5 Gy twice per day with median total dose with brachytherapy of 40.5Gy in radical and 27Gy for EBRT cases. The EBRT median total was 46Gy. HDR Interstitial Brachytherapy was initiated from next day of implant and after removal of the catheters, the patients were followed up as per the institutional protocol and were assessed for survival outcomes and toxicities. Results With a median follow-up of 18 months, 4 local recurrences were observed within first year of follow up after the procedure. The 2-year local control and overall survival outcomes for the entire group were 58.3% and 83.3%, respectively. The 4-year disease free survival was 50% and distant metastases was seen in 33.3% at 5 years. There were 3 patients with Grade II and 4 with Grade III complications and one patient developed osteoradionecrosis. A median BED of 88Gy showed improved survival outcomes in these patients. Conclusion The results of HDR Interstitial brachytherapy have shown an acceptable local control and overall survival rates along with tolerable toxicities and morbidity in recurrent H&N cancers. Based on these encouraging results, prospective clinical trials are warranted using HDR Interstitial Brachytherapy in recurrent H&N cancers to decrease late toxicity. [ABSTRACT FROM AUTHOR]