NONSURGICAL ALTERNATIVE THERAPY FOR BULKY ADVANCED HEAD AND NECK TUMORS

Objective: To rapidly induce symptomatic relief and local tumor contro l in bulky advanced head and neck tumors without surgery. Design: A re trospective analysis of the results with palladium 103-labeled or iodi ne 125-labeled brachytherapy (BT) and adjunctive external beam radiati on therapy (EBRT);a survival analysis by the Kaplan-Meier method; and a comparison of results between the BT/EBRT and EBRT/BT (or BT alone) groups by the log-rank test. A nonsurgical alternative therapy was giv en to a total of 51 patients who presented with tumors of more than 10 0 cm(3) in volume. Results: Moderate to complete symptomatic relief wa s observed in 31 (61%) of 51 patients. Seven (33%) of 21 patients in t he BT/EBRT group and two (7%) of 30 in the EBRT/BT group were recurren ce-free at 36 months. The difference was significant by the log-rank t est. Cause-specific and overall 36-month survivals were 23% and 5%, re spectively. Conclusion: Cure rate by conventional therapy in bulky adv anced head and neck tumors is dismal. The palladium 103- or iodine 125 -BT/EBRT offers good symptomatic relief and an acceptable probability of recurrence-free survival.