Head & Neck

Delivering personalized radiation to tightly controlled areas.

Innovative Treatment Option for Local Control of Head and Neck Cancer

Cesium-131 is an innovative treatment for locally-recurrent, resectable head and neck cancer. The convenience of a single, targeted radiation treatment dose at the time of surgery is both effective for providing targeted therapeutic treatment and convenient to the patients.

Treatment of head and neck cancer depends on the stage and location of the cancer. For early stage disease, a treatment strategy including both surgery and radiation therapy might be the best option, while for more advanced disease, may be a need to add chemotherapy. In both of these situations, the delivery of an effective Cesium-131 treatment for head and neck cancer requires a team approach, including a surgeon, radiation oncologist and a medical oncologist.

Brachytherapy with Cesium-131 may be used in the management of various head and neck tumor sites, including the tonsil and soft palate, base of tongue, and the lip. The use of an implant in the lip, oral tongue, and base of tongue has the advantage of being a functional organ-preserving treatment strategy. In specific circumstances, it may be used as an alternative to surgery for selected cancers of the floor of the mouth. (1)

A brachytherapy implant with Cesium-131 may also be an option for patients with disease recurrence, as it can deliver additional dose to the tumor site, with an increased but acceptable risk of soft-tissue necrosis. A brachytherapy implant may also be used for postoperative irradiation in the setting of a close or positive surgical margin.

Cesium-131 brachytherapy involves the permanent placement of radioactive seeds along the tumor bed following surgery. This precise placement of radiation allows your physician to target the radiation to the region where the tumor is located, while minimizing dose to surrounding healthy tissues. Finally, brachytherapy treatment with Cesium-131 combines the radiation treatment with the surgical procedure, allowing the patient to return to activities following surgical recovery, without the need for additional radiation procedures.

Competitive Experience

While external beam radiation therapy (EBRT) is not invasive, it does have the potential to result in certain side effects, which may present over time, including:

  • Mild Tiredness – This should resolve within a few weeks of the end of radiation treatment
  • Skin Irritation – Including redness, peeling or blistering, swelling, tenderness and pain
  • Difficulty and / or pain when swallowing
  • Change in voice – along with swelling of the voice box and hoarseness
  • Hair loss
  • Weight loss

According to the American Cancer Society

The opportunity to use Cesium 131 has opened an opportunity of treatment, in the form of brachytherapy, that has long been known to be effective, but difficult to deliver.  The ability to deliver high concentrated radiation treatment in a tightly controlled area at the time of surgery really allows us to customize and individualize cancer treatment for our patients.

Dr. Adam J. Luginbuhl, MD

Otolaryngology/Head & Neck Surgery - Head & Neck Cancers, Thomas Jefferson University Hospital

Resources

1. Anthony Pham, BS , Shruthi Arora, MD , A. Gabriella Wernicke, MD, MSc, David I. Kutler, MD, Marc Cohen, MD, William Kuhel, MD, Samuel Trichter, MS , Dattatreyudu Nori, MD, Silvia C. Formenti, MD, Bhupesh Parashar, MD. Cesium-131 brachytherapy in high risk and recurrent head and neck cancers: first report of long-term outcomesBrachytherapy. 2011 Nov-Dec;10(6):508-13. doi: 10.1016/j.brachy.2011.04.002. Epub 2011 Jun 2.

2. Parashar B1, Wernicke AG, Pavese A, Singh P, Trichter S, Sabbas A, Kutler DI, Kuhel W, Port JL, Lee PC, Nori D, Chao KS. Cesium-131 permanent seed brachytherapy: dosimetric evaluation and radiation exposure to surgeons, radiation oncologists, and staff. Brachytherapy. 2011 Nov-Dec;10(6):508-13. doi: 10.1016/j.brachy.2011.04.002. Epub 2011 Jun 2.

3. Christopher Fleming, Andreas Rimner, Gil’ad N. Cohen, Kaitlin M. Woo, Zhigang Zhang, Kenneth E. Rosenzweig, Kaled M. Alektiar, Michael J. Zelefsky, Manjit S. Bains, Abraham J. Wu. High- and low-dose-rate intraoperative radiotherapy for thoracic malignancies resected with close or positive margins Brachytherapy. 2016 Mar-Apr;15(2):208-15. doi: 10.1016/j.brachy.2015.11.007. Epub 2016 Jan 26.

4. (P093) Cesium-131 Brachytherapy in High-Risk and Recurrent Head and Neck (HN) Cancers: Long-Term Results of a Pilot StudyOncology (Williston Park). 2015 Apr 21;29(4 Suppl 1). pii: 205155.

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