Long lasting second remission and quality of life following brachytherapy of relapsing cancer in preirradiated regions. Experience in 108 patients

Introduction: In patients with unresectable relapsing malignant tumor following external beam radiotherapy retreatment by brachytherapy gives a second chance of good palliation and even cure. But regardless the great number of tumor relapse reirradiation is given only to few patients due to the impending risks of severe radiation sequelae. Material and method: From January 1st 1992 to December 31st 1995 overall 108 patients with histologically proven local tumor relapses in preirradiated regions were reirradiated by interstitial or intraluminal brachytherapy (192-Iridium sources). The preirradiation dose was 40 to 70 Gray (Gy) in conventional fractionation. The brachytherapy retreatment dose was 30 to 40 Gy at the individually shaped reference isodose shell. In high dose-rate technique (about two third of all patients) mostly single doses of 5 Gy were applied once or twice a week. If low dose-rate techniques were used, a maximum dose of 60 Gy was applied. In some cases a second course of external beam radiotherapy was added. The sites of reirradiation were: ear-nose-throat-yaw areas 76, large airways 24, soft tissues 7, scalp 1. Results: In (23(108)) patients (21 %) complete or partial remission could be achieved lasting at least one year. In (8(23)) patients (overall 7,4 %) the second remission lasted longer than two years. The quality of life in the long time survivors was felt to be good or at least acceptable. Local necroses, not life threatening, occurred in about 20 %. No fatal complication was to be observed. Altogether in about 85 % the reirradiation resulted in effective palliation and was well tolerated. Discussion and conclusion: Retreatment by brachytherapy yields valuable palliation to the vast majority of patients and gives a second chance of long time good quality survival to about 10 % of all retreated patients. Careful selection of patients and experienced realisation of brachytherapy is essential to avoid severe complications