Interstitial HDR Brachytherapy for Advanced Recurrent Squamous Cell Carcinoma of the Head and Neck

Background: Surgical treatment remains the mainstay therapy for recurrence of head and neck cancer after previous radiotherapy. In inoperable cases, interstitial high-dose rate brachytherapy is a treatment option for local dose escalation. Patients and Methods: A retrospective analysis of all patients who were treated solely with brachytherapy for advanced non-resectable recurrences of squamous cell carcinomas of the head and neck and who previously received radiotherapy was performed. Results: A total of 12 patients with advanced recurrences were treated with interstitial brachytherapy with a fraction dose of 2-3 Gy and a total focal dose of 20-33 Gy. The shortest survival after brachytherapy was 4 weeks. The longest clinical course without evidence of local recurrence is 4 years and 11 months. Conclusion: In selected cases brachytherapy can be used as the last-line or palliative therapy for patients with advanced recurrence head and neck carcinomas. Possible complications and the reduction of quality of life due to tracheostomy should be considered. Despite initially successful application of different combination therapies for squamous cell carcinomas of the head and neck, local recurrences cannot be avoided, with locoregional recurrence rates reaching approximately 15% to 50% (1-4). In these cases, patient care is ideally managed in a multidisciplinary setting. Various therapeutic modalities have been applied for the treatment of local recurrent disease, such as surgery, radiotherapy, and chemotherapy, alone or in combination. Especially for patients with prior radiation, cases of unresectable tumors, and cases complete surgical excision of the tumor where results in severe anatomic and functional defects, treatment options are limited. Interstitial brachytherapy can be used as a single measure or in combination with other treatment modalities. Interstitial high-dose rate brachytherapy (HDRB) allows for high-dose delivery into the tumor with sharp dose fall-off for the surrounding tissue. The efficacy of brachytherapy in unresectable advanced recurrence as a sole treatment modality has only rarely been studied in literature. The aim of the present study was to analyze patients who were solely treated with brachytherapy for unresectable, prior- irradiated, advanced recurrent squamous cell carcinoma of the head and neck.