Analysis of early complications in patients with locoregional recurrences of head and neck carcinoma after combined surgery and HDR brachytherapy treatment - A preliminary report

Introduction. Local or nodal recurrences after primary combined treatment of advanced head and neck cancer (H&N) pose as a very difficult clinical problem; almost 50% of these patients do not fulfil the criteria for salvage surgery or any other radical treatment. Patient groupa are heterogeneous - they differ as to primary treatment and tumour localization, while the lack of detailed information concerning locoregional advancement, surgical margin status and descriptions of surgical procedures further complicate the issue. In view of these facts, the best choice for salvage treatment seams to be surgery, followed by interstitial brachytherapy. Aim. To evaluate the tolerance of treatment in patients with heal and nodal H&N recurrence treated with salvage surgery and interstitial HDR brachytherapy. Material and method. We evaluated 15 patients with recurrent local or locoregional H&N squamous cell cancer, primarily treated with surgery and radiotherapy in other institutions treated at the Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology in Gliwice between January 2001 and April 2003. In the entire group the intended secondary treatment was radical surgery, with implantation of catheters into the tumour bed. The pathological status of surgical margins in salvage surgery was negative in 8 patients, close in 4 cases and positive in 3 cases. HDR brachytherapy was started 2 days after surgery: 10 patients received 2 fractions per day to a total dose of 32-36 Gy and 5 patients - one daily fraction of 5 Gy to a total dose of 20 Gy. The total treatment time ranged from 4 to 6 days, depending on the schedule. Results. Partial necrosis of the rotational flap and the free flap was observed in 2 patients. The pectoral muscle flap was used in 6 cases - for the reconstruction of the floor of the mouth, the tongue, the lower lip and the pharynx, In these cases we observed no problems with healing. Minor complications in wound healing were observed in 3 patients: 2 required repeated surgery due to impaired wound healing. Altogether, healing complications were observed in 46.6% of patients, 33.3% of whom required surgery and 13.3% repeated reconstructive surgery. We did not observe acute radiation toxicity, nor any problems with the removal of catheters. Conclusions. HDR brachytherapy as adjuvant therapy after surgery is a safe method in the treatment of recurrent H&N cancer associated with an acceptable rate of complications.