Hypofractionated accelerated CT-guided interstitial ¹⁹²Ir-HDR-Brachytherapy as re-irradiation in inoperable recurrent cervical lymphadenopathy from head and neck cancer

Radiother Oncol. 2011 Jan;98(1):57-62. doi: 10.1016/j.radonc.2010.10.025. Epub 2010 Dec 2.


Background: Despite significant improvements in the treatment of head and neck cancer (HNC), lymph node recurrences remain a clinical challenge after primary radiotherapy. The value of interstitial (IRT) brachytherapy (BRT) for control of lymph node recurrence remains unclear. In order to clarify its role a retrospective review was undertaken on the value of computed tomography (CT)-guided IRT high-dose-rate (HDR)-BRT in isolated recurrent disease from HNC.

Patients and methods: From 2000 to 2007, 74 patients were treated for inoperable recurrent cervical lymphadenopathy. All patients had previously been treated with radical radiotherapy or chemoradiation with or without surgery. The HDR-BRT delivered a median salvage dose of 30.0 Gy (range, 12.0-36.0 Gy) in twice-daily fractions of 2.0-5.0 Gy in 71 patients and of 30.0 Gy (range, 10.0-36.0 Gy) in once-daily fractions of 6.0-10.0 Gy in three patients.

Results: The overall and disease-free survival rates at one, two and three years were 42%, 19%, 6%, and 42%, 37% and 19%, respectively. The local control probability at one, two and three years was 67% at all three time points. Grade III-IV complications occurred in 13% of patients.

Conclusions: In patients with inoperable recurrent neck disease from HNC, hypofractionated accelerated CT-guided IRT-HDR-BRT can play an important role in providing palliation and tumor control.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Brachytherapy / adverse effects
  • Brachytherapy / methods*
  • Female
  • Head and Neck Neoplasms / mortality
  • Head and Neck Neoplasms / radiotherapy*
  • Humans
  • Iridium Radioisotopes / therapeutic use*
  • Lymphatic Metastasis
  • Male
  • Middle Aged
  • Neck
  • Neoplasm Recurrence, Local / radiotherapy*
  • Prognosis
  • Radiotherapy Dosage
  • Survival Rate
  • Tomography, X-Ray Computed / methods*


  • Iridium Radioisotopes