Salvage for cervical recurrences of head and neck cancer with dissection and interstitial high dose rate brachytherapy

Salvage therapy in head and neck cancer (HNC) is a controversy issue and the literature is scarce regarding the use of interstitial high-dose rate brachytherapy (I-HDR) in HNC. We evaluated the long-term results of a treatment policy combining salvage surgery and I-HDR for cervical recurrences of HNC. Charts of 21 patients treated from 1994 to 2004 were reviewed. The crude local control rate for all patients was 52.4%. The 5- and 8-years overall (OS) and local relapse-free survival (LRFS) rates were 50%, 42.9%, 42.5% and 28.6%, respectively. The only predictive factor associated to LFRS and OS was negative margin status (p = 0.0007 and p = 0.0002). We conclude that complete surgery is mandatory for long term control and the doses given by brachytherapy are not high enough to compensate for microscopic residual disease after surgery

Braquiterapia de alta taxa de dose associada a radioterapia externa no tratamento de angiossarcoma extenso do couro cabeludo: relato de caso Combination of high-dose rate brachytherapy and external beam radiotherapy for the treatment of advanced scalp angiosarcoma: case report

Os autores apresentam um caso de extenso angiossarcoma do couro cabeludo submetido a radioterapia exclusiva, pela associação de roentgenterapia de ortovoltagem e braquiterapia de alta taxa de dose utilizando um molde. Descrevem os aspectos clínicos, técnicos e a evolução terapêutica. Destacam as particularidades e a utilidade da braquiterapia de alta taxa de dose, nesta situação em particular, e fazem uma análise comparativa das dificuldades e limitações caso a braquiterapia de baixa taxa de dose fosse empregada. Concluem ser a braquiterapia de alta taxa de dose uma opção útil, prática e segura para as lesões neoplásicas superficiais do escalpe, podendo ser considerada uma alternativa ao tratamento com elétrons.<br>The authors report a case of a patient with an extensive angiosarcoma of the scalp that was submitted only to radiotherapy with a combination of orthovoltage roentgentherapy and high-dose rate brachytherapy, using a mould. The clinical and technical features as well as the therapeutic outcome are presented, and the usefulness and peculiarities of high-dose rate brachytherapy for this particular indication is discussed. A comparative analysis of the difficulties and limitations of employing low-dose rate brachytherapy is also presented. The authors concluded that high-dose rate brachytherapy might be an useful, practical and safe option to treat neoplastic lesions of the scalp, and an alternative treatment to electrontherapy