SALVAGE BRACHYTHERAPY OF POSTERIOR PHARYNGEAL WALL SQUAMOUS-CELL CARCINOMA IN A PREVIOUSLY IRRADIATED AREA

Purpose: Brachytherapy performed in patients with posterior pharyngeal wall carcinoma in a previously irradiated area is evaluated in terms of local control, survival, and complications. Methods and Materials: Between January 1982 and July 1993, 14 patients were treated with inte rstitial low dose rate brachytherapy alone for posterior pharyngeal wa ll squamous cell carcinoma in a previously irradiated area (local recu rrences in five cases and second tumors in nine cases). Tumor size ran ged from 1 to 4 cm. No patient had a macroscopic nodal involvement or metastase at the time of diagnosis. Median dose delivered aas 55 Gy (3 9 to 60 Gy). Results: Thirteen patients were assessed far local contro l. Twelve of them achieved complete macroscopic response within 2 mont hs after brachytherapy. Local relapse occurred in five patients, from 5 to 29 months after brachytherapy. One patient developed distant meta statis without loco-regional relapse. Disease free survival was 69, 59 , and 37% at 1, 2, and 5 years, respectively; overall survival was 78, 50, and 21% at 1, 2, and 5 years, respectively. Three patients were s till alive without recurrence (8, 8, and 10 years after treatment). We did not observe any severe acute or delayed toxicity. Conclusion: Bas ed on these results, interstitial brachytherapy should be considered a s a potentially curative treatment for selected patients with posterio r pharyngeal wall squamous fell carcinoma in a previously irradiated a rea. There are no reports in the literature on this subject. (C) 1997 Elsevier Science Inc.