Interstitial low-dose-rate brachytherapy in the treatment of recurrent head and neck malignancies

Grimard, Lával; Esche, B.; Lamothe, André; Cygler, Joanna; Spaans, Johanna N.

doi:10.1002/hed.20422

Cited by 27 publications

(32 citation statements)

References 22 publications

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“…Furthermore, the recurrence rate becomes even higher when the anatomic limitations of the head and neck and the existing comorbidities preclude complete surgical resection, leaving patients with positive surgical margins (21). For these patients, radiation and/or chemotherapy become their only chance for cure (20). The modern evolution of radiation therapy for head and neck cancer, either as a single modality or as combination therapy with chemotherapy, centers on providing the maximum amount of dose to achieve local control while minimizing normal tissue toxicity.…”

Section: Discussionmentioning

confidence: 99%

“…Despite aggressive surgery and postoperative radiation therapy, long-term survival remains low (2), and the majority of treatment failures are due Re-cationic-liposomes showed more uniform and focused liposome distribution where the SPECT/CT fusion image illustrates very little activity outside of the tumor area. However, the animal injected with to locoregional recurrence (20). Furthermore, the recurrence rate becomes even higher when the anatomic limitations of the head and neck and the existing comorbidities preclude complete surgical resection, leaving patients with positive surgical margins (21).…”

Section: Discussionmentioning

confidence: 99%

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Intraoperative 186Re-Liposome Radionuclide Therapy in a Head and Neck Squamous Cell Carcinoma Xenograft Positive Surgical Margin Model

Wang

Bao

Herrera

et al. 2008

Clinical Cancer Research

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Purpose: Positive surgical margins in advanced head and neck squamous cell carcinoma (HNSCC) have a well-documented association with an increased risk of locoregional recurrence and significantly poorer survival. Traditionally, unresectable tumor is treated with postoperative radiotherapy and/or chemotherapy. However, these therapeutic options can delay treatment and increase toxicity. The potential value of intraoperative injection of liposomal therapeutic radionuclides as a locoregional, targeted therapy in unresectable advanced HNSCC was assessed in a nude rat xenograft positive surgical margin model. Experimental Design: The therapeutic effects of h-emission rhenium-186 ( 186 Re) carried by liposomes into the tumor remnants in a nude rat squamous cell carcinoma xenograft model were studied. Following the partial resection of tumor xenografts, the animals were intratumorally injected with 186 Re-labeled or unlabeled (control) neutrally charged or positively charged 100-nm-diameter liposomes. Tumor size, body weight, hematology, and toxicity were monitored for 35 days posttherapy. Results: The neutral (n = 4) and cationic (n = 4) liposome control groups showed an increase in tumor growth of 288.0 F 37.3% and 292.2 F 133.7%, respectively, by day 15.The 186 Re-neutralliposome group (n = 8) and the 186 Re-cationic-liposome group (n = 8) presented with an average final tumor volume of 25.6 F 21.8% and 28.5 F 32.2%, respectively, at the end of the study (day 35). All groups showed consistent increases in body weight. No significant systemic toxicity was observed in any of the animals. Conclusions: With excellent tumor suppression and minimal side-effect profile, the intraoperative use of liposomal therapeutic radionuclides may play a role in the management of positive surgical margins in advanced HNSCC.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Intraoperative 186Re-Liposome Radionuclide Therapy in a Head and Neck Squamous Cell Carcinoma Xenograft Positive Surgical Margin Model

Wang

Bao

Herrera

et al. 2008

Clinical Cancer Research

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“…The crude local control rates ranged from 20%-60% with a more favorable outcome observed with second primary than recurrent tumors. 18,20,21 In 1 series of patients treated for regional neck recurrences with brachytherapy, almost 75% died of uncontrolled neck disease. One small series (n 5 20) on reirradiation of early second primary laryngeal cancers showed >90% 5-year survival.…”

Section: Historical Series Of Reirradiation Without Chemotherapymentioning

confidence: 99%

Reirradiation of head and neck cancer using modern highly conformal techniques

Phan

2018

Head & Neck

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Locoregional disease recurrence or development of a second primary cancer after definitive radiotherapy for head and neck cancers remains a treatment challenge. Reirradiation utilizing traditional techniques has been limited by concern for serious toxicity. With the advent of newer, more precise radiotherapy techniques, such as intensity-modulated radiotherapy (IMRT), proton radiotherapy, and stereotactic body radiotherapy (SBRT), there has been renewed interest in curative-intent head and neck reirradiation. However, as most studies were retrospective, single-institutional experiences, the optimal modality is not clear. We provide a comprehensive review of the outcomes of relevant studies using these 3 head and neck reirradiation techniques, followed by an analysis and comparison of the toxicity, tumor control, concurrent systemic therapy, and prognostic factors. Overall, there is evidence that IMRT, proton therapy, and SBRT reirradiation are feasible treatment options that offer a chance for durable local control and survival. Prospective studies, particularly randomized trials, are needed.

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“…However, carotid involvement in persistent disease is relatively common in recurrent disease and carotid artery resection carries significant risk including potential dramatic adverse sequelae, such as cerebrovascular event. Because of the ability to curtail the size of the irradiated volume, brachytherapy seems especially indicated to minimize the risk of severe complications in re-irradiation for persistent/recurrent disease or for new primary tumors located within previously irradiated volumes (33,38,39). …”

Section: Interstitial Radiotherapy (Brachytherapy)mentioning

confidence: 99%

Oral cancer: Current role of radiotherapy and chemotherapy

Huang¹,

2013

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The term oral cavity cancer (OSCC) constitutes cancers of the mucosal surfaces of the lips, floor of mouth, oral tongue, buccal mucosa, lower and upper gingiva, hard palate and retromolar trigone. Treatment approaches for OSCC include single management with surgery, radiotherapy [external beam radiotherapy (EBRT) and/or brachytherapy], as well as adjuvant systemic therapy (chemotherapy and/or target agents); various combinations of these modalities may also be used depending on the disease presentation and pathological findings. The selection of sole or combined modality is based on various considerations that include disease control probability, the anticipated functional and cosmetic outcomes, tumor resectability, patient general condition, and availability of resources and expertise. For resectable OSCC, the mainstay of treatment is surgery, though same practitioners may advocate for the use of radiotherapy alone in selected “early” disease presentations or combined with chemotherapy in more locally advanced stage disease. In general, the latter is more commonly reserved for cases where surgery may be problematic. Thus, primary radiotherapy ± chemotherapy is usually reserved for patients unable to tolerate or who are otherwise unsuited for surgery. On the other hand, brachytherapy may be considered as a sole modality for early small primary tumor. It also has a role as an adjuvant to surgery in the setting of inadequate pathologically assessed resection margins, as does postoperative external beam radiotherapy ± chemotherapy, which is usually reserved for those with unfavorable pathological features. Brachytherapy can also be especially useful in the re-irradiation setting for persistent or recurrent disease or for a second primary arising within a previous radiation field. Biological agents targeting the epithelial growth factor receptor (EGFR) have emerged as a potential moda-lity in combination with radiotherapy or chemoradiotherpy and are currently under evaluation in clinical trials. Key words:Radiotherapy, chemoradiotherapy, oral cavity cancer, treatment.

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Interstitial low-dose-rate brachytherapy in the treatment of recurrent head and neck malignancies

Abstract: Brachytherapy for recurrent head and neck cancer has an acceptable toxicity profile and is viable alternative to EBRT. Further optimization of the best sites and doses for neck brachytherapy is required.

Cited by 27 publications

References 22 publications

Intraoperative 186Re-Liposome Radionuclide Therapy in a Head and Neck Squamous Cell Carcinoma Xenograft Positive Surgical Margin Model

Intraoperative 186Re-Liposome Radionuclide Therapy in a Head and Neck Squamous Cell Carcinoma Xenograft Positive Surgical Margin Model

Reirradiation of head and neck cancer using modern highly conformal techniques

Oral cancer: Current role of radiotherapy and chemotherapy

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