Treatment of 'inoperable' neck nodes using surgical clearance and postoperative interstitial irradiation

The authors describe their experience with postoperative interstitial irradiation (brachytherapy) using after-loaded iridium-192 (192Ir) wires positioned at the site of the tumour after its surgical exposure and debulking or clearance. All the treated patients had previously received external beam irradiation to the neck and in the first three cases local skin necrosis occurred as a sequel to interstitial implantation. Therefore, in the other five patients, cutaneous or myocutaneous flaps were used to resurface the area at the time of implant placement. This combination of techniques, not described previously, provided local tumour control in four out of the five cases without irradiation necrosis occurring in any of them. (author)