Endoscopic ultrasound-guided brachytherapy of head and neck tumours. A newprocedure for controlled application

Brachytherapy is an established procedure in primary and in recurrent cance r. We perform afterloading brachytherapy during general anaesthesia. The ta rget organ is punctured with hollow needles which are loaded with (192)irid ium via remote control. The depth and number of needles depend on tumour ex tension. In the interdisciplinary approach of our departments, this method has been improved and supplied by B-scan ultrasound control. Needles are po sitioned under continuous ultrasonographic guidance, and adjacent structure s (e.g. the carotid artery) are localized ultrasonographically. Thus violat ion of the large vessels is avoided and the exact position of the needles w ithin the tumour is improved. In this paper, we report results on 22 patients suffering from recurrent ca rcinoma of the head and neck following surgery and curative radiation, and 17 patients with first onset of cancer. We did not observe any severe compl ications such as haemorrhage, osteomyelitis, or dyspnoea. The only side-eff ect was temporary oedema, sometimes associated with a short-term increase o f pain. No systemic side-effects occurred. The method is described and results from both patient groups are reported i n detail. We conclude from our data that ultrasonographically-controlled en doscopic brachytherapy is a valuable procedure in locally-advanced primary, and in recurrent head and neck cancer.