The Laryngoscope V C 2012 The American Laryngological, Rhinological and Otological Society, Inc. The Role of High-Dose-Rate and Pulsed-Dose-Rate Brachytherapy in the Management of Recurrent or Residual Stomal Tumor After Total Laryngectomy Anna Bartochowska, MD, PhD; Janusz Skowronek, MD, PhD; Malgorzata Wierzbicka, MD, PhD; Malgorzata Leszczy  nska, MD, PhD; Witold Szyfter, MD, PhD Objectives/Hypothesis: The main purpose of the study was to assess the role and efficacy of high-dose-rate (HDRBT) and pulsed-dose-rate (PDRBT) brachytherapy in the palliative treatment of recurrent or residual stomal tumor after total laryngectomy. Study Design: We aimed at presenting a series of 22 consecutive patients treated in the Department of Otolaryngology, Head and Neck Surgery of Pozna n University of Medical Sciences, and in the Brachytherapy Department of Greater Poland Cancer Center. Methods: In 16 patients PDRBT was used and in six patients HDRBT was used. In three patients, BT procedures were performed in combination with simultaneous chemotherapy. Two patients were additionally treated with interstitial hyper- thermia. In 16 patients, surgical cytoreduction of the tumor preceded the catheters placement. In six patients, a second course of BT was performed due to neck metastases. All patients were regularly followed up within 6 months. Local control, complications, and survival were assessed. Results: Complete and partial remissions 6 months after finishing the treatment were achieved in four (20%) patients, while survival rates 24 months after BT were estimated for 22%. Severe late complications occurred in two (9%) patients. Conclusions: The results of our study show that HDRBT and PDRBT are feasible in previously irradiated patients with recurrent or residual stomal tumor after total laryngectomy. They provide acceptable toxicity and good palliative effect. Key Words: HDR, brachytherapy, PDR, laryngeal cancer, stomal recurrence, palliative treatment. Level of Evidence: 4. Laryngoscope, 123:657–661, 2013 INTRODUCTION Stomal recurrence of laryngeal cancer is considered to be one of the most serious complications after total laryngectomy. It constitutes a very difficult therapeutic issue and always requires individualized management. Preoperative tracheotomy, advanced preoperative T- and N-classification, and subglottic invasion have been docu- mented to be major risk factors for the recurrence in stomal region. 1–3 The management of stomal recurrence including chemotherapy, external beam radiation ther- apy (EBRT), and surgery has been reported as unsatisfactory. Treatment can often only be of a sympto- matic and palliative nature. 4–6 Brachytherapy constitutes a method that has gained actuality in the treatment of recurrent or advanced head-and-neck-cancers. Derived from ancient Greek words for short distance (brachios) and treatment (therapy), it refers to the therapeutic use of encapsulated radionuclides placed within or close to a tumor. It is an internal radiation therapy that is applied either in a per- manent or temporary manner, often through the use of catheters into which the radioactive sources are placed. Because the radiation source is close to or within the target volume, the dose is determined largely by inverse-square considerations, and decreases rapidly as the distance from the applicator increases. Different types of brachytherapy according to the dose rate deliv- ered to the tumor can be distinguished. In the high-dose rate brachytherapy (HDRBT), large doses (>12 Gy/h) can be given within a few minutes. The use of such high-dose rates (1–3 Gy/min) carries a greater ratio of late tissue effects, which in practice can be overcome by careful placement of catheters and by good immobility achievable with very short exposures. Pulsed-dose rate (PDRBT) treatment is a recent brachytherapy modality that combines physical advantages of HDRBT technol- ogy (isodose optimization, planning flexibility, and radiation safety) with radiobiological advantages of low- dose-rate brachytherapy (repair advantages). It involves short pulses of radiation (3 Gy/h), which can be utilized From the Department of Otolaryngology, Head and Neck Surgery (A.B., M.W., M.L., W.S.), Pozna n University of Medical Sciences; and the Brachytherapy Department (J.S.), Greater Poland Cancer Center, Pozna n, Poland. Editor’s Note: This Manuscript was accepted for publication on August 22, 2012. The authors have no funding, financial relationships, or conflicts of interest to disclose. Send correspondence to Anna Bartochowska, MD, PhD, Depart- ment of Otolaryngology, Head and Neck Surgery, Pozna n University of Medical Sciences, 49 Przybyszewskiego Street, 60-355 Pozna n, Poland. E-mail: annabartochowska@gmail.com DOI: 10.1002/lary.23739 Laryngoscope 123: March 2013 Bartochowska et al.: Brachytherapy of Recurrent or Residual Stomal Tumor 657