INTRAOPERATIVE RADIOTHERAPY - 5 YEARS OF EXPERIENCE IN THE PALLIATIVETREATMENT OF RECURRENT AND ADVANCED HEAD AND NECK CANCERS

Recurrent and advanced cancer in the head and neck region is usually a ssociated with limited therapeutic concepts and a dismal prognosis, Ef forts mainly focus on palliative treatment in order to improve the pat ient's quality of life, From May 1989 to December 1994, a total of 120 intra-operative radiotherapy (IORT) procedures with high-energy elect ron beams (mean energy: 7 MeV; mean dose: 20 Gy) were performed in 95 patients, Therapy was usually performed under endotracheal anaesthesia (84%), There were 91 cases (75.8%) of recurrence in the lymph nodes o f the neck and 14 cases (11.7%) of local recurrence. 15 patients (12.5 %) received IORT as part of the initial treatment. Considering the pal liative nature of IORT in these patients, only an R-2 resection (gross residual tumour) was achieved in 71.7%. Local tumour control was none theless possible in 17% (R-2 resection) to 64% (complete R-0 resection ), with a mean 11-month follow-up period for survivors (mean for decea sed patients: 8 months). Regarding palliative criteria, IORT proved to be feasible since patients profited from short hospitalisation (media n: 10 days), a low complication rate (27 instances; e.g. tracheostomy: 11, necrosis: 8, or fistula: 3) and, in part, a substantial reduction of pain (73.8%), Most of them regained physical and psychic integrity for weeks to months and were able to take part in social life during the final stage of their disease.