A 56-year-old patient was treated for cancer of the left lingual edge by left glossectomy and left cervical lymphadenectomy, pT4N2bM0 positive surgical margin. The patient received concurrent three-dimensional adjuvant radiotherapy.
In November 2007 (18 months) we observed a right laterocervical mass, level II, 4cm and 29mm in CT.
Negative extension study.
Pathological anatomy: carcinoma.
Considered unresectable in the Committee of Tumors of the Neck and Throat (CTCC) due to doubts regarding the lack of coordination of the skeletal muscle, chemotherapy (cisplatinum six cycles) and reevaluation
In May 2008, cervical MRI showed partial remission (24mm).
We evaluated CTCC using functional cervical lymphadenectomy modified right with resection of the jugular vein and spinal nerve encompassed by a tumor mass, followed by interstitial HDRBT (June 2008), placing the vectors.
After total removal, the tumor bed and risk organs (carotide, brachial plexus) were identified by the surgeon and oncologist.
We used single-plane implant with five plastic tubes (separated 1cm minimizing risk of vascular toxicity) and comfort buttons (piel-catheter fixation) Nucletron®.
We used sections (5mm) of helicate CT for therapeutic simulation.
Pathological anatomy of metastases from squamous cell carcinoma poorly differentiated in 4 nodes from lymph nodes with non-resectable adenocarcinoma was consistent in all cases.
The planning volume of HDRBT was defined as 5mm from the center of the catheter.
The total dose of 34Gy (10 Buildings) started at 3.4Gy, 2 [separated 6 hours], 5 consecutive days), was 5 days after surgery.
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As a multidisciplinary follow-up we evaluated: functional status, physical examination, toxicity, TSH value, and cervical CT.
In February 2011, the patient is free of disease, good general condition, without pain, such as chronic toxicity: fibrosis grade I soft tissues (criteria of the National Cancer Institute [version 3.0]).
