Permanent Interstitial Cesium-131 Brachytherapy in Treating High-Risk Recurrent Head and Neck Cancer: A Prospective Pilot Study

Michael Kharouta, Chad Zender, Tarun Podder, Rod Rezaee, Pierre Lavertu, Nicole Fowler, Jason Thuener, Shawn Li, Kate Clancy, Zhengzheng Xu, Min Yao, Michael Kharouta, Chad Zender, Tarun Podder, Rod Rezaee, Pierre Lavertu, Nicole Fowler, Jason Thuener, Shawn Li, Kate Clancy, Zhengzheng Xu, Min Yao

Abstract

Purpose/objectives: To establish the feasibility and safety of intraoperative placement of cesium-131 (Cs-131) seeds for re-irradiation in recurrent head and neck cancer (HNC).

Methods: Patients 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.

Results: From 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%.

Conclusions: Cs-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.

Keywords: brachytherapy; cesium 131; head and neck; re-irradiation; recurrence.

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Copyright © 2021 Kharouta, Zender, Podder, Rezaee, Lavertu, Fowler, Thuener, Li, Clancy, Xu and Yao.

Figures

Figure 1
Figure 1
(A) Pre-operative plan showing Cs-131 strand implant location along predicted tumor bed. (B) Post-operative plan showing implanted Cs-131 seeds on diagnostic CT, pre-operative tumor contour in purple.
Figure 2
Figure 2
(A) Cs-131 strands being removed from sterile packaging for implant. Each strand contained a custom number of seeds spaced at 1 cm apart. (B) Exposed resection cavity with several Cs-131 strands implanted per the pre-operative plan.
Figure 3
Figure 3
Kaplan-Meier survival curves following Cs-131 implantation. (A) Overall survival. (B) Disease-free survival. (C) Local failure free survival. (D) Distant failure free survival.

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