An investigation of (125)I seed permanent implantation for recurrent carcinoma in the head and neck after surgery and external beam radiotherapy

BACKGROUND: A preliminary assessment was conducted of the feasibility, efficacy, and morbidity of (125)I seed implantation for recurrent head and neck carcinoma after surgery and external beam radiotherapy. METHODS: Nineteen patients with recurrent head and neck carcinomas underwent (125)I seed implantation under ultrasound or computed tomography guidance. The actuarial D90 of (125)I seed implantation ranged from 90 to 160 Gy (median, 131 Gy). The follow-up period ranged from 3 to 44 months (median, 11 months). RESULTS: The median local control was 24 months (95% confidence interval, 10.2 to 37.8). The one- year, two-year and three-year local controls were 73.3%, 27.5% and 27.5%, respectively, whereas the one-year, two-year and three-year survival rates were 53.0%, 18.2% and 18.2%, respectively, and the median survival was 13 months (95% confidence interval, 6.6 to 19.4). A total of 26.3% of patients (5/19) died of local recurrence and 21.1% of patients (4/19) died of metastases. One suffered from a grade 1 skin reaction. CONCLUSIONS: (125)I seed implantation is feasible and safe as a salvage treatment for patients with recurrent head and neck cancers. The high local control results and low morbidity merits further investigation.