Single institution implementation of permanent 131Cs interstitial brachytherapy for previously irradiated patients with resectable recurrent head and neck carcinoma

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Purpose: Permanent interstitial brachytherapy is an appealing treatment modality for patients with locoregional recurrent, resectable head and neck carcinoma (HNC), having previously received radiation.Cesium-131 ( 131 Cs) is a permanent implant brachytherapy isotope, with a low average photon energy of 30 keV and a short half-life of 9.7 days.Exposure to medical staff and family members is low; patient isolation and patient room shielding are not required.This work presents a single institution's implementation process of utilizing an intraoperative, permanent 131 Cs implant for patients with completely resected recurrent HNC.Material and methods: Fifteen patients receiving 131 Cs permanent seed brachytherapy were included in this analysis.The process of pre-planning, selecting the dose prescription, seed ordering, intraoperative procedures, post-implant planning, and radiation safety protocols are described.Results: Tumor volumes were contoured on the available preoperative PET/CT scans and a pre-implant treatment plan was created using uniform source strength and uniform 1 cm seed spacing.Implants were performed intraoperatively, following tumor resection.In five of the fifteen cases, intraoperative findings necessitated a change from the planned number of seeds and recalculation of the pre-implant plan.The average prescription dose was 56.1 ±6.6 Gy (range, 40-60 Gy).The average seed strength used was 2.2 ±0.2 U (3.5 ±0.3 mCi).Patients returned to a recovery room on a standard surgical floor and remained inpatients, without radiation safety restrictions, based on standard surgical recovery protocols.A post-implant treatment plan was generated based on immediate post-operative CT imaging to verify the seed distribution and confirm delivery of the prescription dose.Patients were provided educational information regarding radiation safety recommendations.Conclusions: Cesium-131 interstitial brachytherapy is feasible and does not pose major radiation safety concerns; it should be considered as a treatment option for previously irradiated patients with recurrent, resectable HNC.

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