High dose rate brachytherapy for oral cancer

Abstract

Brachytherapy results in better dose distribution compared with other treatments because of steep dose reduction in the surrounding normal tissues. Excellent local control rates and acceptable side effects have been demonstrated with brachytherapy as a sole treatment modality, a postoperative method, and a method of reirradiation. Low-dose-rate (LDR) brachytherapy has been employed worldwide for its superior outcome. With the advent of technology, high-dose-rate (HDR) brachytherapy has enabled health care providers to avoid radiation exposure. This therapy has been used for treating many types of cancer such as gynecological cancer, breast cancer, and prostate cancer. However, LDR and pulsed-dose-rate interstitial brachytherapies have been mainstays for head and neck cancer. HDR brachytherapy has not become widely used in the radiotherapy community for treating head and neck cancer because of lack of experience and biological concerns. On the other hand, because HDR brachytherapy is less time-consuming, treatment can occasionally be administered on an outpatient basis. For the convenience and safety of patients and medical staff, HDR brachytherapy should be explored. To enhance the role of this therapy in treatment of head and neck lesions, we have reviewed its outcomes with oral cancer, including Phase I/II to Phase III studies, evaluating this technique in terms of safety and efficacy. In particular, our studies have shown that superficial tumors can be treated using a non-invasive mold technique on an outpatient basis without adverse reactions. The next generation of image-guided brachytherapy using HDR has been discussed. In conclusion, although concrete evidence is yet to be produced with a sophisticated study in a reproducible manner, HDR brachytherapy remains an important option for treatment of oral cancer.

The effect of microdosimetric 12C6+ heavy ion irradiation and Mg2+ on canthaxanthin production in a novel strain of Dietzia natronolimnaea

“…The different values correspond to curves obtained from the standard graph and use of Equation (4) [29]. These curves assume the effectiveness towards microdosimetry is completely described by the linear α-term in Equation (4) [30]. Fitting two parameters to the limited survival data of these strains would cause large errors because of anticorrelation between α and β values [31].…”

Image-guided high-dose-rate brachytherapy of head and neck – a case series study

“…Due to the necessity of performing visually controlled application, brachytherapy in this area is only possible in case of lip cancer, oral cavity cancer, selected neoplasms of nasopharynx, nasal cavity and nasopharynx, as well as in case of repeated radiotherapy of nodular relapses in the head and neck area [7, 8, 9, 10, 11, 12, 13, 14]. …”

High Dose Rate versus Low Dose Rate Brachytherapy for Oral Cancer – A Meta-Analysis of Clinical Trials

“…Radiotherapy for oral cancer consists of teletherapy and brachytherapy. Brachytherapy showed good efficacy over early cancers of the head and neck [21] and lower damage to normal surrounding tissues, and has become an important therapeutic alternative to conventional radiotherapy for oral cancer in Japan [22].…”

“…Meanwhile, HDR brachytherapy has become more and more popular during the last 3 decades, owing to the development of remote after-loading technology at the aspect of high-intensity radioactive sources, treatment planning software, and sophisticated computerized remote after-loading devices [24]. HDR brachytherapy offers numerous advantages over LDR brachytherapy, including (i) accurate calculations made possible by complete fixation of the guide tubes, (ii) parallel source arrangement with sophisticated technique, (iii) homogeneous dose distribution due to stepping source optimization, (iv) better patient care in normal wards without medical staff radiation exposure, administration on an outpatient basis in several cases [22], and (v) no shifting of seeds within the tissues. However, it is still controversial whether HDR brachytherapy can replace LDR brachytherapy in treating oral cancer, in terms of efficacy and safety [14], [17], [25], [26].…”