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

Abstract

ObjectiveTo compare the efficacy and safety of high dose rate (HDR) and low dose rate (LDR) brachytherapy in treating early-stage oral cancer.Data SourcesA systematic search of MEDLINE, EMBASE and Cochrane Library databases, restricted to English language up to June 1, 2012, was performed to identify potentially relevant studies.Study SelectionOnly randomized controlled trials (RCT) and controlled trials that compared HDR to LDR brachytherapy in treatment of early-stage oral cancer (stages I, II and III) were of interest.Data Extraction and SynthesisTwo investigators independently extracted data from retrieved studies and controversies were solved by discussion. Meta-analysis was performed using RevMan 5.1. One RCT and five controlled trials (607 patients: 447 for LDR and 160 for HDR) met the inclusion criteria. The odds ratio showed no statistically significant difference between LDR group and HDR group in terms of local recurrence (OR = 1.12, CI 95% 0.62–2.01), overall mortality (OR = 1.01, CI 95% 0.61–1.66) and Grade 3/4 complications (OR = 0.86, CI 95% 0.52–1.42).ConclusionsThis meta-analysis indicated that HDR brachytherapy was a comparable alternative to LDR brachytherapy in treatment of oral cancer. HDR brachytherapy might become a routine choice for early-stage oral cancer in the future.

GEC-ESTRO ACROP recommendations for head & neck brachytherapy in squamous cell carcinomas: 1st update – Improvement by cross sectional imaging based treatment planning and stepping source technology

“…To be able to deliver the HDR brachytherapy in a short overall time most institutions use 2 fractions per day with a minimum of 6 h interval that is the time required to allow complete repair of sublethal damage. A metanalysis did not reveal significant differences in outcome compared to LDR, but the data need to be interpreted with caution [17]. Table 1 gives an overview of proposed fractionation schedules for PDR and HDR.…”

“…Complications of the technique include soft tissue necrosis and bone necrosis in 10-30% of the implants using HDR. Meta-analysis of 6 trials constituting 1 randomized trial and 5 controlled trials with 607 patients (LDR = 442, HDR = 160) revealed no statistically significant differences between LDR and HDR in terms of local recurrence, overall mortality and grade 3/4 complications [17]. PDR brachytherapy has also been reported to result in outcomes comparable to that of LDR [16].…”

Modern head and neck brachytherapy: from radium towards intensity modulated interventional brachytherapy

“…A recent meta-analysis of published data indicated that HDR brachytherapy is a comparable alternative to LDR brachytherapy in the treatment of oral cancer. The authors suggest: HDR brachytherapy might become a routine choice for early-stage oral cancer in the future [ 44 ]. Furthermore, data in the literature also underline the fact that neither young nor old age are negative prognostic factors for outcomes with brachytherapy in oral cancer [ 45 , 46 ].…”

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]. …”