10 General Aspects of Head and Neck Brachytherapy

General Aspects of Head and Neck Brachytherapy

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THE GEC ESTROHANDBOOKOF BRACHYTHERAPY | Part II Clinical Practice Version 1 - 30/01/2019

15. REFERENCES

rule out a local recurrence and to evaluate chronic effects and complications, then every six months until the fifth year and then yearly, always screening for a metachronous second primary.

1. 1. Takacsi-Nagy Z, Martinez-Monge R, Mazeron JJ, Anker CJ, Harrison LB. American brachytherapy society task group report: Combined external beam irradiation and interstitial brachytherapy for base of tongue tumors and other head and neck sites in the era of new technologies. Brachytherapy 2017;16:44- 58. 2. Kovacs G, Martinez-Monge R, Budrukkar A, Guinot JL, Johansson B, Strnad V, Skowronek J, Rovirosa A, Siebert FA, Head G-E, Neck Working G. Gec- estro acrop recommendations for head & neck brachytherapy in squamous cell carcinomas: 1st update - improvement by cross sectional imaging based treatment planning and stepping source technology. Radiother Oncol 2017;122:248-254. 3. Hennequin C, Mazeron JJ, Chotin G. How to use the paris system in the year 2001? Radiother Oncol 2001;58:5-6. 4. Gerbaulet A, Pîtter R, Mazeron JJ, Meertens H, Van Limbergen E. The gec- estro handbook of brachytherapyLeuven, Belgium ACCO Ed.; ; 2002. 5. Martínez-Monge R (unpublished data) 6. Tepper JE, Sindelar W, Travis EL, Terrill R, Padikal T. Tolerance of canine anastomoses to intraoperative radiation therapy. IntJ RadiatOncolBiolPhys 1983;9:987-992. 7. Siebert FA, Born T, Haring S, Seefeld F, Kovacs G. A dosimetric analysis of interstitial intensity modulated implants for pelvic recurrences, base of tongue and orbita tumors with specific references to the icru-58. Radiother Oncol 2006;79:298-303. 8. Carl W, Schaaf NG, Chen TY. Oral care of patients irradiated for cancer of the head and neck. Cancer 1972;30:448-453. 9. Kovacs G. Modern head and neck brachytherapy: From radium towards intensity modulated interventional brachytherapy. J Contemp Brachytherapy 2015;6:404-416. 10. Caudell JJ, Schaner PE, Desmond RA, Meredith RF, Spencer SA, Bonner JA. Dosimetric factors associated with long-term dysphagia after definitive radiotherapy for squamous cell carcinoma of the head and neck. Int J Radiat Oncol Biol Phys 2010;76:403-409. 11. Levendag PC, Teguh DN, Voet P, van der Est H, Noever I, de Kruijf WJ, Kolkman-Deurloo IK, Prevost JB, Poll J, Schmitz PI, Heijmen BJ. Dysphagia disorders in patients with cancer of the oropharynx are significantly affected by the radiation therapy dose to the superior and middle constrictor muscle: A dose-effect relationship. Radiother Oncol 2007;85:64-73. 12. Nag S, Martinez-Monge R, Zhang H, Gupta N. Simplified non-looping functional loop technique for hdr brachytherapy. Radiother Oncol 1998;48:339- 341. 13. Ciervide R, Ramos L, Aristu JJ, Montesdeoca N, Martinez-Monge R. Use of customized-mold brachytherapy in the management of malignancies arising in the maxillary antrum after maxillectomy: A dosimetric analysis. Brachytherapy 2011;10:159-162. 14. Nag S, Cano ER, Demanes DJ, Puthawala AA, Vikram B. The american brachytherapy society recommendations for high-dose-rate brachytherapy for head-and-neck carcinoma. IntJRadiatOncolBiolPhys 2001;50:1190-1198. 15. Mazeron JJ, Ardiet JM, Haie-Meder C, Kovacs G, Levendag P, Peiffert D, Polo A, Rovirosa A, Strnad V. Gec-estro recommendations for brachytherapy for head and neck squamous cell carcinomas. Radiother Oncol 2009;91:150-156. 16. Melzner WJ, Lotter M, Sauer R, Strnad V. Quality of interstitial pdr- brachytherapy-implants of head-and-neck-cancers: Predictive factors for local control and late toxicity? Radiother Oncol 2007;82:167-173. 17. Dische S, Saunders M, Barrett A, Harvey A, Gibson D, Parmar M. A randomised multicentre trial of chart versus conventional radiotherapy in head and neck cancer. RadiotherOncol 1997;44:123-136. 18. Horiot JC, Bontemps P, Van Den Bogaert W, Le Fur R, van den Weijngaert D, Bolla M, Bernier J, Lusinchi A, Stuschke M, Lopez-Torrecilla J, Begg AC, Pierart M, Collette L. Accelerated fractionation (af) compared to conventional fractionation (cf) improves loco-regional control in the radiotherapy of advanced head and neck cancers: Results of the eortc 22851 randomized trial. Radiother Oncol 1997;44:111-121.

13.2. Basic follow-up assessment An exhaustive oral and oropharyngeal exploration is mandatory to confirm the good healing of the mucosa, without nodular residual tissues. It is completed with a clinical exam of the neck. Image studies as CT or MRI can be done according to standard practice guidelines, or whenever a recurrence is suspected. The most common complication is soft tissue necrosis that is managed medically with antibiotics, steroids, antalgics, mouthwashes, and proper feeding. A close observation is required to adapt the support treatment for some weeks. Bone necrosis became uncommon once lead gutters were systematically used during intensity modulation with a stepping source. The active tobacco intoxication is a risk factor for necrosis and should be stopped. Vasodilators as Pentoxiphylline and antioxidants as Tocopherol (E vitamin) can be prescribed. Hyperbaric oxygen may be useful in severe cases with surgery remaining the last option. 13.3. The follow-up team A close collaboration between the head and neck surgeon and the radiation oncologist is mandatory. The presence of a soft tissue necrosis must be managed in close cooperation. Biopsies are not recommended unless tumor progression is suspected, because they can worsen the soft tissue necrosis and widen the ulcer. Bone necrosis is often superficial, involving the inner part of the mandible, and is exceptionally transfixing the mandible. In case of no efficacy of medical measures, the resection of the bone specimen of osteonecrosis can be made, until reaching well vascularized tissues. • HN Brachytherapy alone should be considered in the management of small tumors arising in areas of cosmetic or functional importance. • HN Brachytherapy must be considered as a boost after external radiation or chemoradiation when its dose- volume profile is advantageous compared with other boosting modalities and the clinical results of such procedures outweigh the risks associated with the intervention. • Postoperative HN Brachytherapy must be viewed as an alternative to external irradiation in cases with small, accessible, well-delimited CTVs that can be safely covered with brachytherapy. • HN Brachytherapy alone or combined with surgical resection needs to be considered in the multidisciplinary management of previously irradiated recurrent head and neck tumors or secondary tumors arising in a previously irradiated field. 14. KEY MESSAGES