To review a single-institutional experience with the use of intraoperative radiation therapy (IORT) for recurrent head-and-neck cancer.
METHODS AND MATERIALS
Between 1991 and 2004, 137 patients were treated with gross total resection and IORT for recurrence or persistence of locoregional cancer of the head and neck. One hundred and thirteen patients (83%) had previously received external beam radiation as a component of deﬁnitive therapy. Ninety-four patients (69%) had squamous cell histology. Final surgical margins were microscopically positive in 56 patients (41%). IORT was delivered using either a modiﬁed linear accelerator or a mobile electron unit and was administered as a single fraction to a median dose of 15 Gy (range, 10–18 Gy). Median follow-up among surviving patients was 41 months (range, 3–122 months).
The 1-year, 2-year, and 3-year estimates of in-ﬁeld control after salvage surgery and IORT were 70%, 64%, and 61%, respectively. Positive margins at the time of IORT predicted for in-ﬁeld failure (p ? 0.001). The 3-year rates of locoregional control, distant metastasis-free survival, and overall survival were 51%, 46%, and 36%, respectively. There were no perioperative fatalities. Complications included wound infection (4 patients), orocutaneous ﬁstula (2 patients), ﬂap necrosis (1 patient), trismus (1 patient), and neuropathy (1 patient).
Intraoperative RT results in effective disease control with acceptable toxicity and should be considered for selected patients with recurrent or persistent cancers of the head and neck. © 2007 Elsevier Inc.