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

BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.