Iridium-192 brachytherapy in the management of recurrent or secondary tumors of the head and neck region

In order to improve the poor results of treatment of local relapses and secondary tumors interstitial radiotherapy with low-dose-rate Iridium 192 was used. Between 1986 and 1993 68 patients (pts) were treated within multimodality treatment concepts. The staging according to UICC was as follows: I: 13 pts., II: 12 pts., III: 14 pts.; IV: 28 pts. Interstitial hyperthermia was performed in 19 pts. At(11(95)) median follow up was 40 months. Nearly the same 5-year survival rates were achieved by surgery and interstitial radiotherapy alone (N = 18 pts; 38 %), surgery, external beam and interstitial radiotherapy (N = 24 pts., 36 %) or external beam and interstitial radiotherapy ± chemotherapy (N = 14 pts., 36 %), but 5-year local control was slightly better in the surgical group (66 - 68%) compared with the pts., treated by external beam and interstitial radiotherapy (40 %). Patients treated by interstitial radiotherapy alone had the worst results. Only 1 of 12 pts. survived 40 months, 7 of 12 pts relapsed locally until death. Treatment complications were acceptable: (4(68)) (6 %) pts. developed soft tissue necrosis; (3(68)) (5 %) pts. osteoradionecrosis. Our results show that interstitial radiotherapy within a multimodality treatment concept yields sufficient local control and survival with an acceptable complication rate