Title: The Analysis of the outcome with High Dose Rate (H.D.R) Brachytherapy in Oropharyngeal Cancers Either Alone or with External Beam Radiotherapy (EBRT)
Authors: Dr C.S.K. Prakash, M.D (R.T), Dr Kamreddy Ashok Reddy, M.S (ENT),Dr Lakkaraju Ravindra Babu, B.D.S
DOI: https://dx.doi.org/10.18535/jmscr/v4i10.121
Purpose: We analysed the results of 34 patients of oropharyngeal carcinomas treated with HDR brachytherapy alone or with EBRT Patients and Methods: The outcome of patients treated with oropharyngeal cancers treated with HDR interstitial or mould brachytherapy alone or with EBRT were analysed. The patients underwent treatment between 2004and 2009 at M.N.J. Institute of Oncology and Regional Cancer Centre, Hyderabad. The minimum follow up period was 24 months. Patients with T1, T2 lesions received EBRT 50Gy. T3 lesions had 56Gy and T4 lesions had 60 Gy. Patients with residual neck nodes had 10Gy of additional electron boost. Patients having no palpable neck nodes had interstitial brachytherapy. For all patients 3 Gy per fraction, for 5-6 fractions, with 2 fractions per day with minimum interval between two fractions was 6 hours. The first and the last fraction the dose of 4Gy was administered instead of 3Gy. Six patients with carcinoma hard palate were treated with HDR mould brachytherapy with 42-45Gy/14-15Fractions. The outcome was analysed. Results: Patients with T1 and T2 lesions 90%patients ,while 78.57%) T3, T4 lesions had no evidence of recurrence and none of the patients with T1, T2 developed complications and 7.14% of T3, T4 patients had complications like necrosis or necrosis and fistulae. Patients with T1N0M0 hard palate carcinomas, treated by mould brachytherapy had 100% local control rates and 0% long term complications of radiotherapy. Conclusion: Oropharyngeal carcinomas can be best treated with combination of EBRT and HDR brachytherapy. Hard palate T1N0M0 lesions can be best treated by HDR mould brachytherapy, thereby reducing overall treatment time and complications. Keywords: Oropharyngeal carcinomas and High Dose Rate (HDR) brachytherapy. 1. Barrs, D M; Desanto.L.W et al. Squamous cell carcinoma of the tonsil and tongue- Base region. Arch Otolaryngeal 105:479-485,1979. 2. Terz , JJ;Richmond. V et al. Carcinoma of tonsillar fossa. Surgery 125:581-590,1967. 3. Syed AMN, Puthawala AA et al. After loading interstitial Implant in head and neck cancer. Arch Otolaryngol 106:541-546,1980. 4. Guix B,Guix JR, Treatmento de los carcinomas cutaneous de losparpados. Arch Otolaryngol1975:35:121-129. 5. Daly NJ, Makissard L, Douches J et al. Technique d’ endocurietherapie parfil d’iridium dans leb eiteliomas cutanes. J Radiol Electrol 1978:59:361-364. 6. Ashby MA,Pacella JA,De Groot R,et al. Use of radon mould technique for skin cancers. Results from the Peter Mac Callum Cancer Institute. Br. J.Radiology 1989;62:608-612. 7. Van der Lanrse R. New implementation in VPS Version 10 and itsdifferencesfrom VPS Version 9.11. Nucletron manual. Veenendal. The Netherlands: Nucletron: 1991. 8. Vander Laarse R. Optimization of high dose rate brachytherapy.Activity: These-lectron user’s Newsletter 1989;2:14-15. 9. Brock A, Pohlmann S, Prages W. Surface Application for HDR Brachytherapy in thehead and neck region. Selectron Brachytherapy J Suppl 1992:3:22-25. 10. Flynn A. Qualityassurance Checks on a microselectron HDR. Brachytherapy.J 1990;4:112-115 11. chu A,Flecher GH: Incidence and causes of failure to control by irradiation the primary lesions in squamous cell carcinoms of anterior two-thirds of the tongue and floor of mouth. AJR1973;117:502-508. 12. Mendelhall WM, VanCise WS ,Hova I.J,Million RR Analysis of time dose fractionation in Squamous cell carcinoma of the oral tongue and floor of the mouth treated with radiation therapy alone. Int J Radiation oncology Biol Phys 1981:7:1005-1011. 13. Fu KK, Licher A,Galante M: Carcinoma Floor of Mouth : An analysis of treatment results and the sites and causes of failures. Int J Radiation oncology Biol Phys 1976:1 829-837. 14. Goffinet DR,Harrison LB. 192 iridium implantation of the base of tongue. . Int J Radiation oncology Biol Phys 1991: 21;867. 15. Harrison LB, Zelefsky MJ et al .Base of tongue cancers treated with External Beam Radiation plus brachytherapy. Oncologic and functional outcome. Radiology 1992:184;267-270. 16. Puthawala AA, Syed AMN Eads DL et al Limited External Beam Radiation plus interstitial iridium implant in the treatment of Squamous cell carcinoma of the tonsillar region. Int J Radiation oncology Biol Phys 1985;11:1595-1602. 17. Puthawala AA, Syed AMN Eads DL et al Limited External Beam Radiation plus interstitial iridium implant in the treatment of Squamous cell carcinoma of the base of the tongue. A ten year experience. Int J Radiation oncology Biol Phys 1988;14:839-848. 18. Dixit S, Baboo HA, Rakesh V, Bhavsar D. Interstitial and High Dose Rate (HDR) brachytherapy in head and neck cancers: Preliminary results.J Brachytherapy Int; 1997;13:363-370. 19. Yu L, Vikram B, Chadha M et al. High Dose Rate Interstitial brachytherapy in head and neck cancers. Endocuriether/ Hypertherm Oncolo1996:12:1-6. 20. Fleming ID, Cooper JS, Henson DE, et al. AJCC Cancer Staging Mannual. 5th edition.Philadelphia: JB Lippincott :1997.p 31-39. 21. Subir Nag, Elmer R. Cano et al. The American Brachytherapy Society Recommendations for HDR brachytherapy for Head –And-Neck carcinoma. . Int J Radiation oncology Biol Phys vol 50:2001;1190-98. 22. Subir Nag, Elmer R. Cano et al .The simplified non looping functional loop technique for HDR brachytherapy. . Int J Radiation oncology Biol Phys 1998;48;339-341. 23. Shukovsky, LJ.; Flecher, GH.: Time-dose and tumor volume relation ships in theirradiation of squamous cell carcinoma of the tonsillar fossa. Radiology 107:621-626,1973. 24. Richard, P ; Tapley , ND.: Lateralized lesions of the oral cavity and oropharynx treated in the part with the electron beam. . Int J Radiation oncology Biol Phys vol 5:461-465, 1979. 25. Ajmel A. Puthawala, A.M.Nisar Syed , et al : Limited external irradiation and Interstitial 192 Iridium implant in the treatment of squamous cell arcinoma of the tonsillar region. . Int J Radiation oncology Biol Phys vol 11: 1595-1602, 1985. 26. Don R. Goffinet et al. 192 Iridium pharyngoepiglottic fold interstitial implants. The key to successful treatment of base tongue carcinoma by radiation therapy. Cancer 55: 941-948,1985.Abstract
References