INTRAOPERATIVE BRACHYTHERAPY, LARYNGOPHARYNGOESOPHAGECTOMY, AND GASTRIC TRANSPOSITION FOR PATIENTS WITH RECURRENT HYPOPHARYNGEAL AND CERVICAL ESOPHAGEAL-CARCINOMA
Ld. Wilson et al., INTRAOPERATIVE BRACHYTHERAPY, LARYNGOPHARYNGOESOPHAGECTOMY, AND GASTRIC TRANSPOSITION FOR PATIENTS WITH RECURRENT HYPOPHARYNGEAL AND CERVICAL ESOPHAGEAL-CARCINOMA, The Laryngoscope, 108(10), 1998, pp. 1504-1508
Citations number
25
Categorie Soggetti
Otorhinolaryngology,"Medicine, Research & Experimental
Objective: To evaluate the role of laryngopharyngoesophagectomy (LPE),
intraoperative I-125 brachytherapy (IOBT), and gastric transposition
(GT) in patients with recurrent carcinoma involving the hypopharynx, o
r cervical esophagus. Methods: Between 1988 and 1994 a total of 21 pat
ients were managed with LPE/IOBT/GT. All patients had documentation of
recurrent disease at the hypopharynx or cervical esophagus and had pr
eviously been treated with external-beam radiation (EBRT) to a total m
edian dose of 60 Gy. Median age was 67 years, with 17 male patients an
d four female. IOBT was performed in all cases with permanent I-125 im
plantation. Medical records were retrospectively reviewed. Overall sur
vival, local control, and complications were evaluated. Median follow-
up was 6 months. Results: The median activity of I-125 was 36 mCi, wit
h a median dose of 80 Gy to the region at risk. Fifteen patients had l
ymph node dissections performed in conjunction with LPE, and 10 patien
ts had nodal involvement on pathologic examination. Margins were micro
scopically positive in nine patients, and lymphvascular space invasion
noted in 13. Actuarial survival at 1 and 3 years was 32% and 14%, res
pectively, with patients alive and with local control at 6, 24, 36, an
d 48 months (negative margins). Actuarial local control at 1 and 3 yea
rs was 63%. Complications included fistula in five patients, facial ed
ema in four, protracted facial pain in two, cervical abscess in one, a
nd mucosal hemorrhage in one. Conclusion: Patients with recurrent carc
inoma of the hypopharynx or cervical esophagus after EBRT have an extr
emely poor prognosis. LPE, IOBT, and GT may provide very good local co
ntrol for all candidates and prolonged survival for a small percentage
of patients with an acceptable risk, profile.