Salvage High-Dose-Rate Interventional Radiotherapy (Brachytherapy) Combined with Surgery for Regionally Relapsed Head and Neck Cancers

SIMPLE SUMMARY: Many head and neck cancer patients suffer from recurrence of the tumor after previous treatment. The initial treatment usually entails operation, radiation treatment, chemotherapy, or combinations of these treatments. For those patients who have no distant metastases, there are limited options of curative treatments. Usually, surgery would be the treatment of choice. However, not all patients are operable, and the treatment results are not satisfactory. Interventional high-dose-rate radiotherapy (HDR-IRT, brachytherapy) is a special method of radiotherapy with unique physical properties. Re-irradiation with HDR-IRT combined with surgery improves the outcome and offers the patients a second chance of curative treatment. After three years of the treatment, 88% of the patients had no local recurrences. A minority of patients, approximately 35%, experienced significant yet controllable complications throughout the follow-up duration. We have confidence that this perioperative and multidisciplinary approach yields favorable clinical results with a tolerable incidence of side effects. ABSTRACT: (1) Background: to report on the use of high-dose-rate (HDR) interventional radiotherapy (brachytherapy, IRT) as a salvage treatment for patients with regionally relapsed head and neck cancers. (2) Methods: A retrospective study of 60 patients treated with HDR-IRT for loco-regionally relapsed head and neck cancers at our institution (2016–2020). Treatment procedure, results, and related toxicities were collected. Local and overall survival outcomes were analyzed. (3) Results: The median follow-up was 22.4 months. Twenty-nine (48.3%) patients had locoregional recurrences with a median time of 28.9 months. The local-recurrence free-survival was 88.1% and 37.3% at 3 years and 5 years. At the last follow-up, 21 patients were alive and the median time to death was 24 months. The overall survival was 39.2% and 16.6% at 3 years and 5 years. Collectively, there were 28 events of grade ≥ 3 late toxicities recorded in 21 patients (35%). (4) Conclusions: Salvage HDR-IRT combined with surgery offers a second-line curative treatment option for regionally relapsed head and neck cancers with acceptable outcomes and toxicities.