The Effect of High Dose Rate Interstitial Implant on Early and Locally Advanced Oral Cavity Cancers: Update and Long-Term Follow-Up Study

Abstract

Introduction Brachytherapy, with or without external beam radiation therapy (EBRT), can be an alternative to surgery for organ preservation in early and locally advanced oral cavity cancers. This study aims to evaluate the effect of high dose rate (HDR) interstitial brachytherapy on early and locally advanced squamous cell carcinoma (SCC) of the oral cavity when used alone or as a boost to EBRT. Methods A total of 125 patients with histologically proven stage T1-3/N0-1 SCC of the oral cavity were included in the study. A total of 15 patients with stage I disease received an interstitial implant dose of 3,850 cGy at 350 cGy per fraction, two fractions a day. Another 53 patients had stage II, and 57 patients had stage III disease; these patients received EBRT of 50 Gy in 25 fractions along with an HDR brachytherapy boost of 21 Gy in seven fractions of 3 Gy per fraction twice daily. The stage III patients also received concurrent chemotherapy with injections of cisplatin

Therapeutic Options in Unresectable Oral Squamous Cell Carcinoma: A Systematic Review

“…Three studies 39 , 44 , 46 focused on the use of external beam RT (EBRT) with or without concurrent CT followed by brachytherapy (BT), two of them were clinical trials 44 , 46 and one was a retrospective cohort study. 39 The number of participants for each intervention group varied from 24 39 to 60 44 people.…”

“… 39 The number of participants for each intervention group varied from 24 39 to 60 44 people. One study 39 included patients with clinical stage III/IV oral cancer, one study 46 only included patients with stage III oral cancer, and another study 44 also included other clinical stages. The main outcomes assessed were OS, LRC, and CSS, which were evaluated in two 39 , 44 out of three 39 , 44 , 46 studies ( Table 5 ).…”

“…The main outcomes assessed were OS, LRC, and CSS, which were evaluated in two 39 , 44 out of three 39 , 44 , 46 studies ( Table 5 ).…”

“…Santos 39 assessed the use of EBRT up to 60 Gy plus concurrent CT followed by HDR-BT up to 24 Gy with a median follow-up of 44 months, reporting that the 4-year OS and LRC rate was 68% and 80%, respectively. Similarly, Vedasoundaram 46 assessed the use of EBRT 50 Gy plus CT with cisplatin followed by HDR-BT 21 Gy and reported a CR of 77.2%. Overall, this approach seems to be effective to treat patients with unresectable oral cancer, but more research about it is needed.…”

“…All selected studies were published in English language between 2011 and 2020. There were 15 retrospective cohort studies, 22,[24][25][26]28,34,[36][37][38][39][40][41][42]47,50 eight were prospective cohort studies, 19,23,29,32,33,35,44,46 six were RCTs, 18,21,27,30,31,43 four were clinical trials, 20,45,48,49 and none was case-control study. The sample size varied from 16 27 to 976 42 participants.…”