L.D.R. brachytherapy is the reference treatment for T2N0 tongue carcinoma: The Centre Oscar Lambret experience in 279 patients

Abstract

Interstitial irradiation by Iridium-192 is an alternative for partial glossectomy in the treatment of T1-2 N0 oral tongue carcinoma. From December 1979 to January 1998, 279 patients (245 men, 34 women) were treated for a T2N0 mobile tongue carcinoma by exclusive LDR brachytherapy (BT) with or without neck dissection (ND). Brachytherapy was performed with guide gutter or plastic tubes according to the Paris system with a median total dose of 60 Gy (median dose rate 0.5 Gy/h, Iridium-192 activity :0.59 to 1.67 mCi/cm). The minimum follow-up was 4 and a half years. Half of the patients presented previous and/or successive other malignant tumour (mostly ENT, oesophagus or bronchus). Local control was 79.1 % at 2 years [SE = 2.7] and regional control respectively 75.9 % and 69.5 % at 2 and 5 years [SE = 3] (Kaplan-Meier method). Occult nodes metastasis rate was 44.6 % at systematic dissection (48.2 % with capsular effraction). The 2 and 5-year overall survival was 74.3 % and 46.6 % [SE = 3]. Distant metastasis rate was 5.3 %. Histological lymph nodes involvement was identified as main significant factor on survival. Complications rate was 16.5 % (grade III : 2.9%). Three groups of patients were identified : patients treated by BT and ND, BT + ND + post-operative radiotherapy and BT alone. The 5-year overall survival was respectively 61.8 %, 40.7 % and 30.1 %, local control 83.1 %, 72.4 % and 73.9 % and regional control 82.6 %, 67.7% and 50.7 %. Topography and tumor length were significant loco-regional prognostic factor (p < 0.05). Exclusive LDR BT is the reference treatment for T2 tongue carcinoma in our Centre, giving an excellent regional control and survival.