Permanent iodine-125 implants in postoperative radiotherapy for head and neck cancer with positive surgical margins.

Abstract

Patients with head and neck cancer treated surgically have a high local recurrence rate, unless the surgeon is able to obtain adequate margins of resection. In patients with positive margins, tumor control is suboptimal despite postoperative radiotherapy. We treated 25 consecutive patients, who were at high risk for local recurrence by virtue of positive margins, by modest dose postoperative external-beam irradiation (median 60 Gy) followed by elective iodine 125 (I-125) implantation. With a median follow-up of 1.5 years (range 1-5 years), there were no instances of necrosis, and only one (4%) instance of a local recurrence. Six patients (24%) developed distant metastases. These results indicate that elective I-125 implantation as a part of postoperative radiotherapy is safe enough for a phase III study in patients with positive margins.