MORTALITY AND MORBIDITY WITH INTRAOPERATIVE RADIOTHERAPY FOR HEAD ANDNECK-CANCER

Objective: To critically evaluate the morbidity and mortality associat ed with intraoperative radiation therapy (IORT). IORT allows the deliv ery of large single-doses of radiation to a visible tumor bed with exc lusion (or shielding) of critical normal structures from the treatment field. Morbidity and mortality associated with IORT has been directly studied in abdominal malignancies, but only briefly mentioned in the head and neck literature. Patients and Methods: At the Arthur G. James Cancer Hospital, The Ohio Slate University Medical Center, 53 patient s with advanced head and neck cancer were treated with surgical resect ion and IORT. Twenty of these patients had intraoperative high-dose-ra te (HDR) brachytherapy, whereas the remaining 33 received intraoperati ve electron beam therapy. All patients received 7.5 to 20 Gy of radiat ion. Those treated were reviewed evaluating perioperative mortality, m ajor and minor complications, and length of hospital slay. All patient s have been followed at least 3 months postoperatively. Results: There were no perioperative deaths. Additionally, there was no increase in the number of complications or length of hospital stay associated with the use of IORT. The mean length of hospital stay was 13.0 days. The major complication rate was 16.8%. Of the major complications, 9% were medical and not related to the surgical site, The minor complication rate was 8%. Conclusion: As we strive to increase control of advanced head and neck cancer, IORT may play an exciting role for intensifying the therapy. At this institution, IORT did not. add to the mortality o r morbidity of an aggressive multimodality treatment schema. Copyright (C) 1996 by W.B. Saunders Company.