gms | German Medical Science

27th German Cancer Congress Berlin 2006

German Cancer Society (Frankfurt/M.)

22. - 26.03.2006, Berlin

Interstitial brachytherapy in the treatment of relapse of previously irradiated head and neck tumors

Meeting Abstract

  • corresponding author presenting/speaker Antje Warszawski - Department of Radiotherapy and Special Oncology, Hannover, Deutschland
  • R. Baumann - Department of Radiotherapy and Special Oncology, Hannover
  • A. Eckardt - Department of Oral and Maxillofacial Surgery, Hannover
  • M. Stieve - Department of Otorhinolaryngology, Hannover
  • J.H. Karstens - Department of Radiotherapy and Special Oncology, Hannover

27. Deutscher Krebskongress. Berlin, 22.-26.03.2006. Düsseldorf, Köln: German Medical Science; 2006. DocPO251

The electronic version of this article is the complete one and can be found online at:

Published: March 20, 2006

© 2006 Warszawski et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Purpose: To analyze the efficiency of HDR brachytherapy in the treatment of local relapse in previously irradiated tumors of the head and neck with emphasis on acute and late radiation induced morbidity, locoregional control and survival.

Methods: From November 2001 to December 2004 20 patients in the age of 36 to 95 years (median 60 years) with locally relapsed head and neck tumors were treated with interstitial HDR brachytherapy in a previous irradiated area in curative intention. The re-irradiation of relapse occurred 6 months to 5 years after primary therapy. Primary therapy consisted in 11/20 patients in surgical resection and adjuvant radiotherapy, in 9/20 patients a definitive radio chemotherapy was carried out previously. For re-irradiation in all patients a three dimensional CT-based treatment planning was performed using the ABACUS brachytherapy planning system. The re-irradiation brachytherapy dose ranged from 17.5 to 35 Gy in single doses of 2.5 Gy (2 Gy in one patient) twice daily. A Gammamed 12i HDR remote afterloader with an iridium-192 source was used.

Results: The sites of cancer recurrence were the floor of the mouth and the tongue in 15 patients and the base of the tongue in 5 patients. After a median follow-up of 22 months (range 2 to 42 months) local control was achieved in 70% of patients (14/20 patients). Six patients developed cervical lymph node metastases and/ or local and distant relapse 3 to 18 months after re-irradiation. In one of these patients a salvage lymphonodectomy was successfully performed for nodal relapse. The median progression free survival was 7.8 months. There was no correlation of local control and the interval between primary therapy and re-irradiation or the volume of re-irradiation. In 2 patients persistent ulcers of the oral mucosa occurred. Two patients suffer from an osteonecrosis of the inner part of the mandible.

Conclusions: The management of locoregionally recurrent or second primary tumors in a previously irradiated head and neck volume presents a challenging clinical problem. Only a small subset of patients are candidates for potentially curative surgery.

Interstitial HDR-Brachytherapy as salvage treatment is an effective method in the treatment of local relapse in previously irradiated head and neck tumors despite the risk of significant acute and late toxicities.