Early wound complications in advanced head and neck cancer treated with surgery and Ir-192 brachytherapy

Objectives: Brachytherapy, either as primary or adjuvant therapy, is increa singly used to treat head and neck cancer. Reports of complications from, t he use of brachytherapy as adjuvant therapy to surgical excision have been limited and primarily follow Iodine 125 (I-125) therapy, Early complication s include wound breakdown, infection, flap failure, and sepsis, and late co mplications may include osteoradionecrosis, bone marrow suppression, or car otid injuries. The authors sought to identify the early wound complications that follow adjuvant interstitial brachytherapy with iridium 192 (Ir-192). Study Design: A retrospective chart review of all patients receiving adjuv ant brachytherapy at a tertiary medical center over a 4-year period. Method s: Nine patients receiving Ir-192 brachytherapy via afterloading catheters placed during surgical resection for close or microscopically positive marg in control were evaluated. It was used during primary therapy in six patien ts and at salvage surgery in three. Early complications were defined as tho se occurring within 6 weeks of surgical therapy. Results: The overall compl ication rate was 55% (5/9), and included significant wound breakdown in two patients, minor wound dehiscence in three, and wound infection, bacteremia , and local tissue erosion in one patient each. All complications occurred in patients receiving Bap reconstruction and one patient required further s urgery to manage the complication. Complication rates were not associated w ith patient age, site, prior radiotherapy, timing of therapy, number of cat heters, or dosimetry, Conclusions: The relatively high complication rate is acceptable, given the minor nature of most and the potential benefit of ra diotherapy. Further study should be undertaken to identify those patients w ho will achieve maximum therapeutic benefit without prohibitive local compl ications.