[Palliative intraoperative irradiation of recurrent neck lymph node metastases in the head and neck area].

BACKGROUND

In the course of a malignant tumor disease, metastases in the regional lymph nodes commonly are linked with poor prognosis. Especially in cases of recurrence after surgery and radiation therapy, curative management of the disease can rarely be achieved. Therefore several palliative treatment modalities have been developed. Intraoperative radiation therapy represents one of them it allows a single high-dose irradiation of a region which, in light of the global tumor disorder, cannot be cured by surgical intervention. METHODS/ PATIENTS: Between 1989 and 1994, 70 patients with recurrent metastases in the head and neck lymph nodes were treated with IORT in the ENT Department of the University Hospital Aachen in collaboration with the Radiation Department. Since some patients were irradiated up to four times, 91 operations (77 under general anesthesia and 14 under local anesthesia) and irradiations were performed. During the procedure each, patient had to be transported twice from the standard operating suite to the radiation unit and back.

RESULTS

Regarding the palliative intention of IORT in these cases, we mainly evaluated parameters which had an influence on quality of life of the patients: duration of hospitalization, pain treatment, removal of necrotic tumor mass, and safety of treatment. Depending on the general condition, the patients stayed in the hospital for 3-56 days (median: 10 days). In almost every case, mental and to some extent physical integrity was restored for some time after the disfiguring tumor on the neck had been removed. In nearly 90%, pain treatment could be reduced (e.g., discontinuation of opiate treatment) or further progression could be avoided (74%). Despite the transportation only few complications occurred, which primarily involved healing disturbances (n = 8), fistulas (n = 3), and edemas of the arm (n = 2; after primary treatment of breast cancer). There was no serious infection observed under prophylactic antibiotic treatment in 74% of the cases. Local tumor control (LTC), which only was of minor interest in this treatment group, was possible depending on the extent of tumor resection that could be achieved during the surgical approach: R0 resection = > 50% LTC/R1 resection = > 40% LTC/R2 resection (72.5% of the cases) = > 24.8% LTC. Follow-up of the surviving patients lasted 6-26 months (mean: 14.4 months) but generally did not allow an exact assessment of the time of tumor control.

CONCLUSIONS

IORT of recurrent metastases in the head and neck region in our opinion represents an effective alternative for palliative treatment. Important aspects of the patients' quality of life could be improved, and patients were then able to take part in social life again for some time. On the other hand tumor control was not to be expected since in most of the cases only an incomplete tumor resection was achieved. However, the extent of resection substantially affects local tumor control in the head and neck region.