Abstract
Brachytherapy has become an established therapeutic regimen for primary, persistent, recurrent and metastatic tumour disease in the head and neck region. This study presents the authors’ preliminary experience with intracavitary brachytherapy by means of an individual silicone applicator in the treatment of patients with nasal, sinonasal, orbital and nasopharyngeal cancer. Between January 2001 and January 2013, twenty patients with cancer of the nasal cavity, the paranasal sinuses and nasopharynx underwent surgery and intracavitary brachytherapy with the aid of an individually manufactured silicone applicator in the Department of Otolaryngology, Head and Neck Surgery and in the Department of Radiotherapy and Radiooncology at the Saarland University Medical Center of Homburg, Germany. The tumour was localized in the nasal cavity/paranasal sinuses (15) affecting the orbit twice and the nasopharynx (5). There were 14 patients with squamous cell carcinoma, 2 patients with mixed tumours and one patient with adenocarcinoma, adenoid cystic carcinoma, mucosal melanoma or plasmocytoma. The majority of the patients presented with advanced disease (T3 or T4 tumours). In 18/20 patients, brachytherapy was performed as a boost technique, in the remaining two solely because of a previous radiation series. All surgical interventions were performed endonasally. Three to six weeks after surgery, a cast of the nasal cavity was created under general anaesthesia. Subsequently, an individual brachytherapy silicon applicator with two to four plastic tubes was manufactured. The radiation therapy was applied using the Ir-192 high-dose-rate-afterloading method (total dose 10–20 Gy) in two to five sessions, additionally in 18/20 patients a percutaneous radiotherapy with a total dose of 30–60 Gy was applied. After a mean duration of follow-up of 2 years, 7/20 patients experienced a local progression, 5/19 a regional recurrence in the neck nodes and 4/19 distant metastases. The 2-year survival was 57.3 %. No serious complications were reported. The silicone applicator was well tolerated by all patients. Because of the complexity of the sinonasal anatomy with the finding of mainly advanced tumours, the presented individual silicone brachytherapy applicator has proven to be useful and meaningful for endocavitary brachytherapy of malignancies of the nasal cavities, paranasal sinuses and nasopharynx.
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Petit A, Floquet A, Lasbareilles O, Stoeckle E, Chemin A, Kind M, Guyon F, Brouste V, Pigneux J, Thomas L (2013) Pulsed-dose-rate brachytherapy for uterine cervix carcinoma: 10 years of experience with 226 patients at a single institution. Brachytherapy. doi:10.1016/j.brachy.2013.05.003 (Epub ahead of print)
Aronowitz JN, Robison RF (2010) Howard Kelly establishes gynecologic brachytherapy in the United States. Brachytherapy 9:178–184
Nose T, Komoike Y, Yoshida K, Koizumi M, Motomura K, Kasugai T, Inaji H, Nishiyama K, Koyama H, Kozuka T, Gomi K, Oguchi M, Akahashi Y, Sumida I, Yamashita T (2006) A pilot study of wider use of accelerated partial breast irradiation: intraoperative margin-directed re-excision combined with sole high-dose-rate interstitial brachytherapy. Breast Cancer 13:289–299
Hinnen KA, Schaapveld M, van Vulpen M, Battermann JJ, van der Poel H, van Oort IM, van Roermund JG, Monninkhof EM (2011) Prostate brachytherapy and second primary cancer risk: a competitive risk analysis. J Clin Oncol 29:4510–4515
Shibuya H (2009) Current status and perspectives of brachytherapy for head and neck cancer. Int J Clin Oncol 14:2–6
Levendag PC, Schmitz PI, Jansen PP, Eijkenboom WM, Visser AG, Kolkman-Deurloo IK, Sipkema D, Visch LL, Senan S (1998) Fractionated high-dose-rate brachytherapy in primary carcinoma of the nasopharynx. J Clin Oncol 16:2213–2220
Duthoy W, Boterberg T, Claus F, Ost P, Vakaet L, Bral S, Duprez F, Van Landuyt M, Vermeersch H, De Neve W (2005) Postoperative intensity-modulated radiotherapy in sinonasal carcinoma: clinical results in 39 patients. Cancer 104(1):71–82
Schick B, Weiss R, Niewald M, Schneider MH (2004) Individual silicon applicator for nasopharyngeal brachytherapy. Laryngorhinootologie 83:507–511
Glatzel M, Büntzel J, Schröder D, Küttner K, Fröhlich D (2002) High-dose-rate brachytherapy in the treatment of recurrent and residual head and neck cancer. Laryngoscope 112:1366–1371
Tselis N, Heyd R, Baghi M, Zamboglou N (2008) Interstitial high-dose-rate-brachytherapy in advanced esthesioneuroblastoma. Laryngoscope 118:2006–2010
Turner JH, Reh DD (2012) Incidence and survival in patients with sinonasal cancer: a historical analysis of population-based data. Head Neck 34:877–885
Ibrahim E, Chassagne D, Cachin Y, Haie C (1982) Les epitheliomas du seuil narinaire. A propos de 36 cas traites a l’lnstitut Gustave Roussy de 1961 a 1975. Les Cahiers d’ORL 17:109–117
Amornmarn R, Prempree T, Sewchand W, Jaiwatana J (1983) Radiation management of advanced nasopharyngeal cancer. Cancer 52:802–807
Syed AM, Puthawala AA, Damore SJ, Cherlow JM, Austin PA, Sposto R, Ramsinghani NS (2000) Brachytherapy for primary and recurrent nasopharyngeal carcinoma: 20 years’ experience at long beach memorial. Int J Radiat Oncol Biol Phys 47:1311–1321
Russell JD, Bleach NR, Glaser M, Cheesman AD (1993) Brachytherapy for recurrent nasopharyngeal and naso-ethmoidal tumours. J Laryngol Otol 107:115–120
Levendag PC, Keskin-Cambay F, de Pan C, Idzes M, Wildeman MA, Noever I, Kolkman-Deurloo IK, Al-Mamgani A, El-Gantiry M, Rosenblatt E, Teguh DN (2013) Local control in advanced cancer of the nasopharynx: is a boost dose by endocavitary brachytherapy of prognostic significance? Brachytherapy 12:84–89
Levendag PC, Lagerwaard FJ, Noever I, dePan C, vanNimwegen A, Wijers O, Schmitz PI, van Dieren E, Nowak PJ (2002) Role of endocavitary brachytherapy with or without chemotherapy in cancer of the nasopharynx. Int J Radiat Oncol Biol Phys 52:755–768
Evensen JF, Jacobsen AB, Tausjø JE (1996) Brachytherapy of squamous cell carcinoma of the nasal vestibule. Acta Oncol 35(Suppl 8):87–92
Huang MW, Zheng L, Liu SM, Shi Y, Zhang J, Yu GY, Zhang JG (2013) 125I brachytherapy alone for recurrent or locally advanced adenoid cystic carcinoma of the oral and maxillofacial region. Strahlenther Onkol 189:502–507
Scepanovic D, Paluga M, Rybnikarova M, Pobijakova M, Masarykova A, Kroslak M (2013) Brachytherapy as a treatment for malignant melanoma of the nasal cavity and nasopharynx—case report. J Contemp Brachytherapy 5:157–163
Elidan J, Sela M, Lijovetzky G, Weshler Z (1989) Metastatic maxillary sinus melanoma treated by local excision and brachytherapy. J Otolaryngol 18:293–297
Deutch M, Oral K, Aramany MA (1981) Silicone radioactive seed carrier for nasal neoplasms. J Prosthet Dent 46:88–90
Ghalichebaf M, Chalian VA, Shidnia H (1984) A shielded radiumsource carrier nasal stent for the treatment of primary carcinoma of the nasal cavity. J Prosthet Dent 51:383–386
Lyzak WA, Fleming TJ (1995) Fabrication and use of an intracavitary radiotherapeutic applicator for the posterior sinus wall: a case report. J Prosthet Dent 4:133–136
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Kadah, B.A., Niewald, M., Papaspyrou, G. et al. Customized individual applicators for endocavitary brachytherapy in patients with cancers of the nasal cavity, sinonasal region and nasopharynx. Eur Arch Otorhinolaryngol 273, 1543–1547 (2016). https://doi.org/10.1007/s00405-015-3636-3
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DOI: https://doi.org/10.1007/s00405-015-3636-3