PALLIATIVE INTRAOPERATIVE RADIATION-THERA PY (IORT) OF RECURRENT METASTASES IN LYMPH-NODES IN THE HEAD AND NECK REGION

Background: In the course of a malignant tumor disease, metastases in the regional lymph nodes commonly are linked with poor prognosis. Espe cially in cases of recurrence after surgery and radiation therapy, cur ative management of the disease can rarely be achieved. Therefore seve ral palliative treatment modalities have been developed. Intraoperativ e radiation therapy represents one of them it allows a single high-dos e irradiation of a region which, in light of the global tumor disorder , cannot be cured by surgical intervention. Methods/Patients: Between 1989 and 1994, 70 patients with recurrent metastases in the head and n eck lymph nodes were treated with IORT in the ENT Department of the Un iversity Hospital Aachen in collaboration with the Radiation Departmen t. Since some patients were irradiated up to four times, 91 operations (77 under general anesthesia and 14 under loca anesthesia) and irradi ations were performed. During the procedure each, patient had to be tr ansported twice from the standard operating suite to the radiation uni t and back. Results: Regarding the palliative intention of IORT in the se cases, we mainly evaluated parameters which had an influence on qua lity of life of the patients: duration of hospitalization, pain treatm ent, removal of necrotic tumor mass, and safety of treatment. Dependin g on the general condition, the patients stayed in the hospital for 3- 56 days (median: 10 days). In almost every case, mental and to some ex tent physical integrity was restored for some time after the disfiguri ng tumor on the neck had been removed. In nearly 90%, pain treatment c ould be reduced (e.g., discontinuation of opiate treatment) or further progression could be avoided (74%). Despite the transportation only f ew complications occured, which primarily involved healing disturbance s (n = 8), fistulas (n = 3), and edemas of the arm (n = 2; after prima ry treatment of breast cancer). There was no serious infection observe d under prophylactic antibiotic treatment in 74% of the cases. Local t umor control (LTC), which only was of minor interest in this treatment group, was possible depending on the extent of tumor resection that c ould be achieved during the surgical approach: RO resection double rig ht arrow 50% LTC/R1 resection =, 40% LTC/R2 resection (72.5% of the ca ses) double right arrow 24.8% LTC. Follow-up of the surviving patients lasted 6-26 months (mean: 14.4 months) but generally did not allow an exact assessment of the time of tumor control. Conclusions: IORT of r ecurrent metastases in the head and neck region in our opinion represe nts an effective alternative for palliative treatment. Important aspec ts of the patients' quality of life could be improved, and patients we re then able to take part in social life again for some time. On the o ther hand tumor control was not to be expected since in most of the ca ses only an incomplete tumor resection was achieved. However, the exte nt of resection substantially affects local tumor control in the head and neck region.