THE POTENTIAL USES OF HIGH-DOSE-RATE BRACHYTHERAPY IN PATIENTS WITH HEAD AND NECK-CANCER

Brachytherapy has proven to be an extremely valuable method of treatme nt for head and neck cancer. The data supporting its application, howe ver, is based on continuous low-dose-rate brachytherapy. To benefit fr om improved radiation protection, outpatient treatments, and increased patient tolerance of treatment set-up over that encountered in conven tional low-dose-rate manually afterloaded brachytherapy, we implemente d a high-dose-rate remote afterloading approach in selected patients w ith head and neck cancers. This treatment was utilized in two differen t roles in managing 29 patients. In its first role, it was used as the sole treatment in 13 patients with T1-2 NO malignancies. A total of t en treatments of 450-500 cGy each were delivered twice a day with a mi nimum of 5-6 h between treatments. With a median follow-up of 9 months , only 1 patient failed locally. In a second role, brachytherapy was a pplied in a post-operative adjuvant setting following wide local excis ion of tumors in patients who presented with recurrent disease (12 cas es) or a second primary in the head and neck (4 cases). All patients h ad previously received external irradiation to the head and neck. Due to this previous course of irradiation, only eight treatments of 300 c Gy each were delivered, for a total of 2400 cGy over a period of 4 day s. However, with a follow-up of 2-16 months, only 3 patients remain di sease free.