Treatment of Oral Cavity and Oropharyngeal Cancer

Abstract

Excellent local control rates of interstitial brachytherapy in oral cavity cancer and oropharyngeal carcinoma have been demonstrated in different retrospective studies. Compared to external-beam radiation therapy the high local control rates with a low rate of side effects obtained by interstitial brachytherapy are the result of a steep dose reduction in the implant-surrounding normal tissues. Therefore, interstitial brachytherapy offers rather the possibility to give high doses without inevitably leading to high complication rates. Low-dose-rate (LDR) and pulsed-dose-rate (PDR) interstitial brachytherapy with 0.4-0.55 Gy/h/24 h for tumors of the oral cavity and oropharynx in selected patients is a proven, effective and safe treatment method with excellent long-term data both as a sole treatment modality and a postoperative method, as well as a unique treatment method of head and neck tumors in previously irradiated areas. This paper deals with the technical aspects of interstitial brachytherapy, that seem to be relevant to high-quality outcome, and gives an overview of indications as well as past and recent results of interstitial brachytherapy in head and neck cancer.

A multicenter prospective phase II study of postoperative hypofractionated stereotactic body radiotherapy (SBRT) in the treatment of early-stage oropharyngeal and oral cavity cancers with high risk margins: the STEREO POSTOP GORTEC 2017-03 trial

“…In this study, we hypothesize that the safety and efficacy profiles of postoperative SBRT for early-stage oropharyngeal or oral cavity carcinomas with high risk margins will be similar to other radiotherapy techniques (brachytherapy or fractionated IMRT) [12][13][14][15][16][17][18][19][20][21]. Thus, this technique could become a third alternative option along with fractionated external beam IMRT and brachytherapy.…”

“…Brachytherapy is a highly conformal radiotherapy technique which allows high-dose delivery to small volumes within a short overall treatment time [12,13]. However, implantation is not always technically possible: for example, for tumors that are very close to (< 5 mm) or involve bone, gingiva or the retromolar trigone, as well as parapharyngeal or nasopharyngeal extension for oropharyngeal carcinomas.…”

Three-dimensional verification of 125I seed stability after permanent implantation in the parotid gland and periparotid region

“…The divergence is understandable because radiation-induced tissue shrinkage would be expected to bring seeds closer together in the area where tissue is receiving relative a higher dose. According to the dose distribution pattern, tissues near peripheral seeds received relative lower dose [ 20 , 21 ]. Thus, shrinkage is less pronounced.…”

Role of high dose rate interstitial brachytherapy in early and locally advanced squamous cell carcinoma of buccal mucosa

“…Most of the published literatures in interstitial brachytherapy for oral cavity cancers were based on LDR and manual after loading techniques (Conill et al 2007 ). With the recent advances in 3D image based techniques, the possibility of accurate delineation of the target volumes and optimization of dose distributions have made HDR brachytherapy much safer to patients and disease control better (Harrison 1997 ; Strnad 2004 ).…”