Kharouta Michael, Zender Chad, Podder Tarun, Rezaee Rod, Lavertu Pierre, Fowler Nicole, Thuener Jason, Li Shawn, Clancy Kate, Xu Zhengzheng, Yao Min
Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, OH, United States.
Department of Otolaryngology Head and Neck Surgery, University of Cincinnati School of Medicine, Cincinnati, OH, United States.
Front Oncol. 2021 Mar 18;11:639480. doi: 10.3389/fonc.2021.639480. eCollection 2021.
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).
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.
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%.
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.
ClinicalTrials.gov, identifier NCT02794675.
目的/目标：探讨术中植入铯 - 131（Cs - 131）种子用于复发性头颈癌（HNC）再照射的可行性与安全性。
符合条件的患者为可切除的复发性HNC且被认为有较高二次复发风险者。肿瘤切除后，立即根据术前治疗计划并在术中调整后将种子植入手术床。手术床和种子用局部皮瓣或游离微血管皮瓣覆盖。术后第1天进行颈部CT扫描以评估术后剂量分布。术后1个月和3个月对患者进行随访，之后在前2年每3个月随访一次。
2016年11月至2018年9月，共招募15例患者，12例患者按方案接受治疗。对于植入种子的患者，初始复发部位包括单纯颈部10例、颈部和喉部1例、颈部/造口周围1例。中位随访时间为21.4个月。术后患者住院时间中位数为6天。除2例伤口并发症需要伤口护理外，无高级别毒性反应。8例患者出现复发，3例为单纯局部区域复发，3例为单纯远处复发，2例同时有局部区域和远处复发。仅1例患者出现野内失败。5例患者死亡，1年和2年总生存率分别为75%和58%。
复发性HNC手术切除后植入Cs - 131是可行且安全的。未出现意外的严重毒性反应。大多数失败为野外或远处复发。
ClinicalTrials.gov，标识符NCT02794675。
