GEC-ESTRO ACROP recommendations for head & neck brachytherapy in squamous cell carcinomas: 1st update – Improvement by cross sectional imaging based treatment planning and stepping source technology

Abstract

The Head and Neck Working Group of the GEC-ESTRO (Groupe Européen de Curiethérapie - European Society for Therapeutic Radiology and Oncology) published in 2009 the consensus recommendations for low-dose rate, pulsed-dose rate and high-dose rate brachytherapy in head & neck cancers. The use of brachytherapy in combination with external beam radiotherapy and/or surgery was also covered as well as the use of brachytherapy in previously irradiated patients. Given the developments in the field, these recommendations needed to be updated to reflect up-to-date knowledge. The present update does not repeat basic knowledge which was published in the first recommendation but covers in a general part developments in (1) dose and fractionation, (2) aspects of treatment selection for brachytherapy alone versus combined BT+EBRT and (3) quality assurance issues. Detailed expert committee opinion intends to help the clinical practice in lip-, oral cavity-, oropharynx-, nasopharynx-, and superficial cancers. Different aspects of adjuvant treatment techniques and their results are discussed, as well the possibilities of salvage brachytherapy applications.

Head and neck cancer reirradiation with interstitial high‐dose‐rate brachytherapy

“…Whether or not the clinical intent was curative or palliative, a radiation dose was chosen to maximally achieve local control in the re‐treated field while taking into account other treatments being utilized (such as initial salvage resection) and potential toxicities due to the proximity of organs‐at‐risk. Three‐dimensional imaging‐based treatment planning was utilized, as recommended in the most recent update for head and neck brachytherapy . Mandibular shielding was used, if feasible, in patients when the mandible was undergoing reirradiation.…”

Locoregional failures and their relation to radiation fields following stereotactic body radiotherapy boost for oropharyngeal squamous cell carcinoma

“…Excellent rates of locoregional control were attained in our OPSCC population with a high proportion (60%) of stage III‐IV disease, using accelerated IMRT followed by an SBRT boost. Five‐year local and regional control rates of 90% and 93%, respectively, compare favorably to brachytherapy outcomes in similar patient populations . Previously, we reported a 3‐year local control rate of 94% following brachytherapy boost and 97% following SBRT boost, with no statistical difference in local control between the two modalities; however, this included only patients with T1‐T2 tumors .…”

“…Highly conformal dose escalation may potentially improve in‐field control while sparing swallowing structures, salivary glands, and other organs at risk. Brachytherapy has been recommended as one such strategy; however, it is technically demanding with strict patient eligibility criteria . At our institution, a regimen consisting of accelerated intensity‐modulated radiotherapy (IMRT) followed by stereotactic body radiotherapy (SBRT) boost was developed, initially as an option for those ineligible for brachytherapy, but later used standardly for eligible patients with T1‐small T3, N0‐N2 OPSCC.…”

HDR interventional radiotherapy (brachytherapy) in the treatment of primary and recurrent head and neck malignancies

“…American and European societies attempted to systematize along years the indications in different clinical settings based on evidence of the clinical benefits, but a definite comprehensive consensus is lacking . HDR IRT is of course acknowledged as a tool for the treatment of head and neck tumors, and the recommendations concerning patient selection criteria, implant techniques, target volume definition, and HDR treatment parameters, such as time, dose, and fractionation schedules, have been generally comprehensively described .…”

“…American and European societies attempted to systematize along years the indications in different clinical settings based on evidence of the clinical benefits, but a definite comprehensive consensus is lacking . HDR IRT is of course acknowledged as a tool for the treatment of head and neck tumors, and the recommendations concerning patient selection criteria, implant techniques, target volume definition, and HDR treatment parameters, such as time, dose, and fractionation schedules, have been generally comprehensively described . However, even if it has become clear that brachytherapy may also be used in recurrences, especially in already irradiated fields, its specific value in many clinical situations and in particular in the tricky post‐EB recurrent setting is not yet fully exploited.…”