Introduction: Surgery is the primary treatment for resectable, non-metastatic recurrent head and neck squamous cell carcinoma (HNSCC). We explore the safety and oncologic benefit of intraoperative Cesium-131 (Cs-131) brachytherapy combined with salvage local and/or regional surgical resection.
Methods and materials: Findings were reported from a single arm multi-institutional prospective phase 1/2 trial involving surgery plus Cs-131 (surgery + Cs-131) treatment. The results of two retrospective cohorts-surgery alone and surgery plus intensity modulated radiation therapy (surgery + ReIMRT)-were also described. Included patients had recurrent HNSCC and radiation history. Safety, tumor re-occurrence, and survival were evaluated.
Results: Forty-nine patients were enrolled in the surgery + Cs-131 prospective study. Grade 1 to 3 adverse events (AEs) occurred in 18 patients (37%), and grade 4 AEs occurred in 2 patients. Postoperative percutaneous endoscopic gastrostomy (PEG) tubes were needed in 10 surgery + Cs-131 patients (20%), and wound and vascular complications were observed in 12 patients (24%). No cases of osteoradionecrosis were reported in the surgery + Cs-131 cohort. We found a 49% 2-year disease-free survival at the site of treatment with a substantial number of patients (31%) developing metastatic disease, which led to a 31% overall survival at 5 years.
Conclusions: Among patients with local/regional recurrent HNSCC status-post radiation, surgery + Cs-131 demonstrated acceptable safety with compelling oncologic outcomes, as compared to historic control cohorts.
Clinical trial registration: ClinicalTrials.gov, identifiers NCT02794675 and NCT02467738.
Luginbuhl, Adam J.; Calder, Alyssa; Kutler, David; Zender, Chad; Wise-Draper, Trisha; Patel, Jena; Cheng, Michael; Karivedu, Vidhya; Zhan, Tingting; Parashar, Bhupesh; Gulati, Shuchi; Yao, Min; Lavertu, Pierre; Takiar, Vinita; Tang, Alice; Johnson, Jennifer; Keane, William M.; Curry, Joseph; Cognetti, David; and Bar-Ad, Voichita, "Multi-Institutional Study Validates Safety of Intraoperative Cesium-131 Brachytherapy for Treatment of Recurrent Head and Neck Cancer" (2021). Department of Otolaryngology - Head and Neck Surgery Faculty Papers. Paper 60.
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