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Disease-free survival rates of tongue cancer treated with highdose-rate (HDR) interstitial brachytherapy.
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It has been demonstrated that the outcome of primary radiotherapy in squamous cell carcinomas of the head and neck is strongly influenced by overall treatment time. The purpose of this study was to evaluate the results of high-dose-rate (HDR) interstitial brachytherapy (ISBT) for early mobile tongue cancer and to examine whether the non-irradiated...
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To investigate the influence of a 3D image-based treatment-planning method for high-dose-rate interstitial brachytherapy (HDR-ISBT)
for mobile tongue cancer, we analyzed dose–volume histogram results for the clinical target volume (CTV) and the mandible.
Between October 2010 and November 2011, one and four patients having T2 and T3 tumors, respecti...
Purpose:
To point out the advantages and drawbacks of high-dose rate brachytherapy in the treatment of mobile tongue cancer and indicate the clinical importance of modular lead-lined spacers when applying this technique to patients.
Methods:
First, all basic steps to construct the modular spacer are shown. Second, we simulate and evaluate the do...
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Citations
... We first arranged a HDR radiation source (Iridium-192) in either a single or double plane (for large tumors). Following Tsai et al. (6) and Kakimoto et al. [20] who reported that 50-60 Gy would be the maximum dose, we set 60 Gy at 5 mm offset from the lateral source. We simulated the absorbed dose at 10, 15, 20, 25, 30, 35, 40 mm distance from the lateral source combined with a varying lead thickness (0-5 mm). ...
Purpose:
To point out the advantages and drawbacks of high-dose rate brachytherapy in the treatment of mobile tongue cancer and indicate the clinical importance of modular lead-lined spacers when applying this technique to patients.
Methods:
First, all basic steps to construct the modular spacer are shown. Second, we simulate and evaluate the dose rate reduction for a wide range of spacer configurations.
Results:
With increasing distance to the source absorbed doses dropped considerably. Significantly more shielding was obtained when lead was added to the spacer and this effect was most pronounced on shorter (i.e. more clinically relevant) distances to the source.
Conclusions:
The modular spacer represents an important addition to the planning and treatment stages of mobile tongue cancer using HDR-ISBT.
... Common late complications are osteoradionecrosis and intensified fibrosis. 4,9,11 Complications occur more often in the elderly 9 and in HDR-BT compared to low-dose radiation (LDR) BT and pulse-dose radiation (PDR) BT. 4,11,15 However, the data conflict because some studies reported no correlation between local complications and BT dosage. 9,16,17 Nonetheless, only a few studies have investigated the side effects of reirradiation with HDR after initial external beam irradiation. ...
Objectives/hypothesis:
Despite advances in radiotherapy and chemotherapy treatments for head and neck cancers, the local failure rate is high. In most radiotherapy-resistant cases, surgery is performed; however, some cases are considered unresectable. No standard treatment for these situations has been established. In this study, we review our experience with brachytherapy (BT), which has a different biological mechanism than standard radiotherapy.
Methods:
All patients received prior radiation to the recurrence area. Median high-dose radiation BT dose was 50 Gy, administered in 5 to 10 Gy fractions twice daily for 5 days. High-dose radiation was given via four to 10 catheters inserted under local anesthesia (3 patients) or general anesthesia with preventive tracheostomy (10 patients).
Results:
Thirteen patients received BT from 2010 to 2014. Male:female ratio was 1.6:1, and median age was 66 years (range 23-89). Of those 13 patients, 10 patients were diagnosed with squamous cell carcinoma (SCC) of the oral cavity, two patients with SCC of the nasal mucosa, and one patient with eccrine duct carcinoma. Prior radiation dose ranged from 60 to 70 Gy. Local control was achieved in 11 of 13 patients; only 15.3% (2 of 13) had in-field recurrence. Five patients developed local out-of-field recurrence, and two developed distant metastases. Five patients are alive with no evidence of disease. No major toxicities were encountered. Two patients had severe mucositis and recovered within several weeks.
Conclusion:
Brachytherapy for radiotherapy-resistant head and neck cancers is feasible with minor adverse events, which enables good local control. However, many advanced head and neck cancers develop regional or distant metastases; therefore, additional treatment should be suggested.
Level of evidence:
4. Laryngoscope, 2016.
... With the evolution of afterloading techniques, high-dose-rate brachytherapy (HDR-BT) has replaced LDR-BT in most of the centers in the world. But with HDR, the results are variable [7,11,12,13,14,15]. The latest and largest experience of HDR-BT in early stage oral tongue cancers has been reported in 67 patients in a Japanese experience by Matsumoto et al. [14]. ...
... The clinical outcome in terms of loco regional control rates and survival has been compared among the two groups in this study. The 5-year LCR of 64.2% seen in our patients, was quite lower than the rates reported in literature [2,6,12,13]. On subset analysis according to T stage, the 5 year LCR for stage I and stage II were 74.7% and 52.5%, respectively, which are again inferior compared to the previous reports [13,14,15,16]. ...
Purpose:
To determine outcomes of interstitial high-dose-rate brachytherapy (HDR-BT) in patients with early stage oral tongue cancer.
Material and methods:
Ninety-two patients with stage I and II oral tongue cancer were treated with HDR-BT between 1999 and 2014: brachytherapy alone = 62 (67.4%), and combination of external beam radiotherapy (EBRT) and brachytherapy = 30 (32.6%). Median follow-up was 53.5 months. Patterns of failure, overall survival (OS), disease-free survival (DFS), local control rates (LCR), and nodal control rates (NCR) were determined.
Results:
5-year OS, DFS, LCR, and NCR were 73.2%, 58.2%, 64.2%, and 83.8%, respectively. In total, 43 patients (46.7%) failed treatment: isolated local failures = 28 (30.4%), isolated nodal failures = 8 (8.7%), both local and regional failures = 7 (7.6%). While in T1 stage, 5 year LCR were significantly higher in brachytherapy alone group compared to combined EBRT and brachytherapy group (81.7% vs. 62.5%, p = 0.04), the isolated nodal failure rates were not significantly different among the two groups. For T2 stage, NCR were higher in combined EBRT and brachytherapy group compared to brachytherapy alone (92.9% vs. 74.3%). Acute mucositis (grade ≥ 2) was seen more in brachytherapy alone group compared to the combined modality group (87% vs. 66%), and this correlated significantly with the higher biological equivalent dose (BED) in the brachytherapy alone group.
Conclusions:
Our study recommends treating patients with brachytherapy alone in T1 stage, and demonstrates the need for addressing nodal region either by neck dissection or nodal irradiation in T2 stage patients. Also, the study highlights the need for dose escalation (from the doses used in the study) in both T1 and T2 stage tumors when using interstitial brachytherapy either as sole modality or as a boost.
... В последнее время в клиническую практику входят аппараты, использующие технологию автоматизированного переноса элемента (afterloading system) в расчетную точку аппликатора по подводящим каналам, а затем возвращения его в хранилище и работающие с источниками высокой мощности дозы (HDR). В исследованиях, сравнивавших эти 2 режима для лечения опухолей головы и шеи, не было выявлено достоверных отличий в локальном контроле [10][11][12]. Брахитерапия в режиме HDR с величиной разовых доз в пределах 3-4 Гр по локальному контролю и лучевым реакциям была сопоставима с режимом LDR. ...
... Для 66 пациентов, леченных комбинированно с использованием дистанционной ЛТ и брахитерапии, СОД составила 12,5-60 (средняя доза -30) Гр для дистанционного компонента и 50-120 (средняя доза -68) Гр за 1 нед для LDR и 32-60 (средняя доза -48) Гр за 8-10 фракций в течение 5-7 дней для HDR. В результате лечения 2-и 3-летний безрецидивный период для пациентов после LDR-и HDRбрахитерапии существенно не отличался и составил примерно 68 %: 67 и 71 % соответственно [10,11]. [21]. ...
Background. One of the methods of radiotherapy of malignant tumors of oral cavity and oropharyngeal region today is interstitial radiation therapy – brachytherapy, allowing you to create the optimum dose of irradiation to the tumor, necessary for its destruction, without severe radiation reactions in the surrounding tissues unchanged. Brachytherapy has the following advantages: high precision – the ability of the local summarization of high single doses in a limited volume of tissue; good tolerability; a short time of treatment. At this time, brachytherapy is the method of choice used as palliative therapy and as a component of radical treatment.Objective: The purpose of this article is a literature review about the latest achievements of interstitial brachytherapy in malignant tumors of the oral cavity and oropharynx.
... Yamazaki tongue 48-60 Gy/8-10#/ 5 yr LC -84% et al. [30] 6-7 days Kakimoto tongue 54-60 Gy/9-10#/ 5 yr LC -85.9% et al. [31] 5-7 days OS -80.3% Table 3. Results of exclusive HDR brachytherapy in tongue carcinoma ...
In Poland, the classical LDR brachytherapy for head and neck carcinomas with Ir-192 wires or hairpins has completely disappeared some time ago after 30 years of successful clinical use. Can this technique be fully and safely replaced by HDR or PDR application? This option seems attractive because of new possibilities of 3D reconstruction and computer real-time treatment planning and optimization. However, in my opinion, long time is needed to get a clinical and scientific experience that has been accumulated for decades with the use of LDR technique.
The head and neck (H&N) region is among the most intricate and functional part of our anatomy. Major functional nerves and blood vessels with importance that affect the entire body emanate from the base of skull. Brachytherapy plays an important role as a single modality therapy in early cancer of the lip and oral cavity and a supplemental role in the pharynx or in advanced or recurrent disease. Morbidity in the H&N is intensely personal and disabling. Its avoidance is critical in determining the success or failure of a treatment program, and it is essential to preservation of quality of life. This article summarizes the current literature regarding morbidity related to H&N brachytherapy to aid patients and physicians to achieve optimal outcomes.
The purpose of the study was to evaluate the influence of interstitial postoperative brachytherapy for the vitality and quality of flaps used for reconstruction of tissue defects after head and neck cancer salvage resection. We aimed at presenting six consecutive patients with recurrent squamous cell carcinoma in head and neck region who underwent salvage surgery and tissue reconstruction with a regional or free flap followed by brachytherapy. Reconstruction was performed with a free radial forearm flap in 2 cases, with a free thigh flap in 2 cases, and with a myocutaneous lateral upper arm flap in the next 2 cases. In all patients, pulsed-dose-rate brachytherapy was used with a median value of 0.7 Gy (range 0.6–0.8 Gy) per pulse and a median total dose of 20 Gy (range 20–40 Gy). In the analyzed group, there were no serious wound and flap complications after brachytherapy. In one case, peripheral skin necrosis was noticed. No revision surgery was needed but only surgical debridement of the necrotic margins. All wounds healed within 14 days after surgery as well as donor sites which healed within 4 weeks. Based upon our data, pulsed-dose-rate brachytherapy seems to be a safe option that can be performed at the site of reconstruction in immediate postoperative period with minimal wound complications and with no impact on flap survival. Further clinical study based on larger patient series is needed to present statistically proven results.
Interstitial brachytherapy （ISBT） for oral cancer patients, especially for tongue cancer patients, is one of the radical treatments because of high local control rate and preservation of oral function. Low-dose-rate （LDR） ISBT was the main treatment modality in ISBT for oral cancer patients. However LDR ISBT has the problems of irradiation for medical staff and radioactive source supply, and so on. High-dose-rate （HDR） ISBT can resolve these problems of LDR ISBT. This review was conducted to report the advantage of HDR ISBT for oral cancer patients, the treatment method of HDR ISBT for tongue cancer patients, the treatment results of HDR ISBT for tongue cancer patients, and the modular resin spacer with lead for HDR ISBT correspondent to CT based image guided brachytherapy.
The application of high-dose-rate (HDR) interstitial brachytherapy (ISBT) has expanded to many areas such as the treatment of cervical cancer, endometrial cancer, vaginal cancer, prostate cancer, and breast cancer. Likewise, HDR-ISBT is also regularly used to treat oral cavity cancers, as it offers high local control rates and low toxicity. Advantages of HDR-ISBT to treat oral cancers include (1) accurate dose calculations which are made possible by complete fixation of the flexible treatment catheters, (2) parallel source arrangement through a linked double-button technique or custom-made vinyl template technique, (3) homogeneous dose distribution by stepping-source optimization through computer simulations, (4) the absence of direct radiation exposure to the medical staff, and (5) better patient care using ordinary hospital wards. Three-dimensional image-guided HDR-ISBT has laid the groundwork for forming a stepping-source technology which offers the advantage of optimizing dose distribution by varying dwell times. Additionally, this technique allows for real dose optimization guidance to elicit homogeneous dose distribution to a planning target volume, thereby reducing dose spillover to the organ at risk. The current chapter will elucidate some of the (1) benefits of HDR-ISBT, (2) treatment methods, (3) results of the definitive treatment of HDR-ISBT for oral cancer patients, (4) a mold technique, and (v) a CT-compatible modular spacer with lead shield. In conclusion, HDR-ISBT is an important treatment option when dealing with oral cancer.
Brachytherapy is a standard, safe, and effective treatment for head and neck cancer. It is used alone (monotherapy) in early lip, buccal, and oral cavity cancer to preserve cosmesis, structure, and function or it is given postoperatively in cases with close or positive surgical margins. It is usually combined with external beam radiation therapy for advanced oral cavity, oropharynx, or nasopharynx cancers. It is also indicated in previously irradiated patients to salvage local or regional recurrences. The highly targeted (conformal) radiation dose reduces injury and side effects (morbidity) to vital structures and organs. The dose may be delivered continuously (low dose rate or LDR), in hourly pulses (pulsed dose rate or PDR), or more commonly, in a short series of once or twice daily treatments (high dose rate or HDR).
