Intraoperative radiation therapy for advanced cervical metastasis: a single institution experience

Radiation Oncology

Tod Huntley²  Robert Borrowdale²  Edward Krowiak²  Stephen Freeman²  Colin Terry⁴  Daniel Weed³  Alex Yeh³  Youssef H Zeidan¹ 

[1] Department of Radiation Oncology, Stanford University, Stanford, CA, USA;Center for Ear Nose Throat & Allergy, Indianapolis, IN, USA;Department of Radiation Oncology, Methodist Hospital, Indianapolis, IN, USA;Methodist Research Institute, Methodist Hospital, Indianapolis, IN, USA

关键词: cervical metastasis;    IORT;    intraoperative radiotherapy;   

Others  :  1224328
DOI  :  10.1186/1748-717X-6-72

 received in 2011-01-18, accepted in 2011-06-15,  发布年份 2011

【 摘 要 】

Background

The purpose of this study is to review our experience with the use of IORT for patients with advanced cervical metastasis.

Methods

Between August 1982 and July 2007, 231 patients underwent neck dissections as part of initial therapy or as salvage treatment for advanced cervical node metastases resulting from head and neck malignancies. IORT was administered as a single fraction to a dose of 15 Gy or 20 Gy in most pts. The majority was treated with 5 MeV electrons (112 pts, 50.5%).

Results

1, 3, and 5 years overall survival (OS) after surgery + IORT was 58%, 34%, and 26%, respectively. Recurrence-free survival (RFS) at 1, 3, and 5 years was 66%, 55%, and 49%, respectively. Disease recurrence was documented in 83 (42.8%) pts. The majority of recurrences were regional (38 pts), as compared to local recurrence in 20 pts and distant failures in 25 pts. There were no perioperative fatalities.

Conclusions

IORT results in effective local disease control at acceptable levels of toxicity. Our results support the initiation of a phase III trial comparing outcomes for patients with cervical metastasis treated with or without IORT.

【 授权许可】

   
2011 Zeidan et al; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]Mendenhall WM, Million RR, Cassisi NJ: Elective neck irradiation in squamous-cell carcinoma of the head and neck. Head Neck Surg 1980, 3:15-20.
• [2]Mendenhall WM, Million RR: Elective neck irradiation for squamous cell carcinoma of the head and neck: analysis of time-dose factors and causes of failure. Int J Radiat Oncol Biol Phys 1986, 12:741-746.
• [3]Freeman SB, Hamaker RC, Singer MI, Pugh N, Garrett P, Ross D: Intraoperative radiotherapy of skull base cancer. Laryngoscope 1991, 101:507-509.
• [4]Freeman SB, Hamaker RC, Singer MI, Pugh N, Garrett P, Ross D: Intraoperative radiotherapy of head and neck cancer. Arch Otolaryngol Head Neck Surg 1990, 116:165-168.
• [5]Willett CG, Czito BG, Tyler DS: Intraoperative radiation therapy. J Clin Oncol 2007, 25:971-977.
• [6]Calvo FA, Meirino RM, Orecchia R: intraoperative radiation therapy part 2. Clinical results. Crit Rev Oncol Hematol 2006, 59:116-127.
• [7]Calvo FA, Meirino RM, Orecchia R: Intraoperative radiation therapy first part: rationale and techniques. Crit Rev Oncol Hematol 2006, 59:106-115.
• [8]Freeman SB, Hamaker RC, Borrowdale RB, Huntley TC: Management of neck metastasis with carotid artery involvement. Laryngoscope 2004, 114:20-24.
• [9]Freeman SB, Hamaker RC, Rate WR, Garrett PG, Pugh N, Huntley TC, Borrowdale R: Management of advanced cervical metastasis using intraoperative radiotherapy. Laryngoscope 1995, 105:575-578.
• [10]Ang KK, Harris J, Wheeler R, Weber R, Rosenthal DI, Nguyen-Tan PF, Westra WH, Chung CH, Jordan RC, Lu C, et al.: Human papillomavirus and survival of patients with oropharyngeal cancer. N Engl J Med 363:24-35.
• [11]Chen AM, Bucci MK, Singer MI, Garcia J, Kaplan MJ, Chan AS, Phillips TL: Intraoperative radiation therapy for recurrent head-and-neck cancer: the UCSF experience. Int J Radiat Oncol Biol Phys 2007, 67:122-129.
• [12]Pinheiro AD, Foote RL, McCaffrey TV, Kasperbauer JL, Bonner JA, Olsen KD, Cha SS, Sargent DJ: Intraoperative radiotherapy for head and neck and skull base cancer. Head Neck 2003, 25:217-225; discussion 225-216.
• [13]Nag S, Schuller DE, Martinez-Monge R, Rodriguez-Villalba S, Grecula J, Bauer C: Intraoperative electron beam radiotherapy for previously irradiated advanced head and neck malignancies. Int J Radiat Oncol Biol Phys 1998, 42:1085-1089.
• [14]Nag S, Schuller D, Pak V, Grecula J, Bauer C, Young D: IORT using electron beam or HDR brachytherapy for previously unirradiated head and neck cancers. Front Radiat Ther Oncol 1997, 31:112-116.
• [15]Nag S, Schuller D, Pak V, Young D, Grecula J, Bauer C, Samsami N: Pilot study of intraoperative high dose rate brachytherapy for head and neck cancer. Radiother Oncol 1996, 41:125-130.
• [16]Freeman SB: Advanced cervical metastasis involving the carotid artery. Curr Opin Otolaryngol Head Neck Surg 2005, 13:107-111.