A Hard Target Needs a Sharper DaRT
Interstitial brachytherapy in the head and neck, in the hands of skilled operators, is an indispensable component of local dose escalation for an otherwise devastating disease process.
This is particularly true for patients with prior radiation or for whom a morbid resection is impossible or cosmetically disfiguring.
Despite a limited accrual of 28 evaluable patients, the authors should be applauded for their execution of an effective trial demonstrating 3 important facets:
Safe and well-tolerated therapy even in elderly and previously irradiated/resected patients, as acute toxicity predominantly resolved by 1 month after treatment. Postimplant radioactivity measurements indicated a minimal risk to radiosensitive tissues, and no acute grade 3 toxicities or any late toxicities were noted, which compares favorably to historical series.
This attribute of DaRT is particularly important because so many patients with recurrent disease are not medically suitable for aggressive treatment.
Demonstration of therapeutic effect in all patients, with nearly 80% achieving complete eradication of clinically evident tumor. The remainder had at least a partial response. Unsurprisingly, radiation-naïve disease responded most vigorously; however, even among previously irradiated patients, a majority were able to achieve a complete response.
Translation of preclinical findings to tangible benefit in the clinic and innovation in our field. This is the first demonstration of alpha particle–based brachytherapy with a defined dose (10 Gy) that is capable of inducing vigorous clinical responses. It raises the question as to whether this approach could have value as an alternative to the more toxic and aggressive treatments that are currently offered.