Head and Neck Publications
Article Name: The American Brachytherapy Society recommendations for high-dose-rate brachytherapy for head-and-neck carcinoma
Author: Subir Nag, M.D., Elmer R. Cano, M.D., D. Jeffrey Demanes, M.D., Ajmel A. Puthawala, M.D., and Bhadrasain Vkram, M.D., for the American Brachytherapy Society
Instutions: Department of Radiation Oncology, Ohio State University, Columbus, OH; Department of Radiation Oncology, Presbyterian University Hospital, Pittsburg, PA; Department of Radiation oncology, The California Endocurietherapy Cancer Center, Oakland, CA; Department of Radiation Oncology, Long Brach Memorial Medical Center, Long Brach, CA,; Department of Radiation oncology, Montefiore Medical Center, Bronx, NY
Published Date: March 2001
To develop recommendations for use of high-dose-rate (HDR) brachytherapy in patients with head-and-neck cancer.
Methods and Materials
A panel consisting of members of the American Brachytherapy Society (ABS) performed a literature review, added information based upon their clinical experience, and formulated recommendations for head-and-neck HDR brachytherapy.
The ABS recommends the use of brachytherapy as a component of the treatment of head-and-neck tumors. However, the ABS recognizes that some radiation oncologists are reluctant to employ brachytherapy in the head-and-neck region because of the complexity of the postoperative management and concerns about radiation safety. In this regard, HDR eliminates unwanted radiation exposure and thereby permits unrestricted delivery of clinical care to these brachytherapy patients. The ABS made specific recommendations for previously untreated and recurrent head-and-neck cancer patients on patient selection criteria, implant techniques, target volume definition, and HDR treatment parameters (such as time, dose, and fractionation schedules). Suggestions were provided for treatment with HDR alone and in combination with external beam radiation therapy. It should be recognized that only limited experiences exist with HDR brachytherapy in patients with head-and-neck cancers. Therefore, some of these suggested doses have not been extensively tested in clinical practice. Hence, these guidelines will be updated as significant new outcome data are available. Any clinician following these guidelines is expected to use clinical judgment to determine an individual patient's treatment.
Little has been published in the clinical literature on HDR brachytherapy in head-and-neck cancer. Based upon the available information and the clinical experience of the panel members, general and site-specific recommendations were offered. Areas for further investigations were identified.
Article Name: Wire in Leader Technique: A method for loading implant catheters in inaccessible sites
Author: D. Jeffrey Demanes, MD, , Ph.D., MD, Nisar Syed, MD, Ajmal Puthawala, MD
Published Date: October 1997
Medical Journal: Journal of Brachytherapy International, Vol. 13, Number 4, October, 1997
Interstitial brachytherapy has traditionally been used in visibly accessible sites only. Expansion of the role of brachytherapy to the management of cancers in less exposed regions is now possible. The "wire in leader" technique allows loading of interstitial catheters when the stainless steel trocar tips are not visibly exposed for direct insertion of the leader portion of the catheter. The method is described in several figures and descriptions related to the base of tongue, an illustrative but not unique example.