High-dose-rate brachytherapy plus neck dissection for nodal disease

Background. Regional control for advanced nodal disease has been only marginally affected by concurrent chemoradiation, hyperfractionation, concomitant boost, or accelerated external radiation. Methods. Twenty-five necks in 24 patients received brachy-therapy treatment (20 Gy in 10 twice-daily fractions) in addition to external radiation, neck dissection ± chemotherapy. Indications for brachytherapy included initial treatment of bulky disease (n = 12), recurrence of neck disease in a previously treated patient with at least a 3-month disease-free interval (n = 6), persistent disease after a curative efforts (n = 4), inadequate external radiation (ie, <40 Gy) due to either intolerance or noncompliance (n = 3). Results. Overall actuarial regional control was 67% at 2 years. Regional control for those receiving brachytherapy as part of their initial treatment was 82% despite a mean nodal diameter of 8.7 cm (range, 5-15 cm). The 2-year actuarial regional control was 56% for the patients with a disease-free interval of at least 3 years. Conclusion. High-dose-rate brachytherapy produced excellent regional control.