Intra-operative radiotherapy--5 years of experience in the palliative treatment of recurrent and advanced head and neck cancers

• Published in: Oncology Vol. 54; no. 3; p. 208
• Main Authors: Spaeth, J, Andreopoulos, D, Unger, T, Beckman, J, Ammon, J, Schlöndorff, G
• Format: Journal Article
• Language: English
• Published: Switzerland 01-05-1997
• Subjects: Adult; Aged; Aged, 80 and over; Female; Head and Neck Neoplasms - radiotherapy; Head and Neck Neoplasms - secondary; Head and Neck Neoplasms - surgery; Humans; Intraoperative Care; Male; Middle Aged; Neoplasm Recurrence, Local - pathology; Neoplasm Recurrence, Local - radiotherapy; Neoplasm Recurrence, Local - surgery; Neoplasm Staging; Palliative Care - methods; Radiotherapy Dosage; Radiotherapy, Adjuvant; Treatment Outcome
• ISSN: 0030-2414
• DOI: 10.1159/000227690

Recurrent and advanced cancer in the head and neck region is usually associated with limited therapeutic concepts and a dismal prognosis. Efforts mainly focus on palliative treatment in order to improve the patient's quality of life. From May 1989 to December 1994, a total of 120 intra-operative radiotherapy (IORT) procedures with high-energy electron beams (mean energy: 7 MeV: mean dose: 20 Gy) were performed in 95 patients. Therapy was usually performed under endotracheal anaesthesia (84%). There were 91 cases (75.8%) of recurrence in the lymph nodes of the neck and 14 cases (11.7%) of local recurrence. 15 patients (12.5%) received IORT as part of the initial treatment. Considering the palliative nature of IORT in these patients, only an R2 resection (gross residual tumour) was achieved in 71.7%. Local tumour control was nonetheless possible in 17% (R2 resection) to 64% (complete R0 resection), with a mean 11-month follow-up period for survivors (mean for deceased patients: 8 months). Regarding palliative criteria, IORT proved to be feasible since patients profited from short hospitalisation (median: 10 days), a low complication rate (27 instances; e.g. tracheostomy: 11; necrosis: 8, or fistula: 3) and, in part, a substantial reduction of pain (73.8%). Most of them regained physical and psychic integrity for weeks to months and were able to take part in social life during the final stage of their disease.