Abstract
Purpose/ObjectivesThe purpose of this study is to describe a novel brachytherapy technique for lip Squamous Cell Carcinoma, utilizing a customized mold with embedded brachytherapy sleeves, which separates the lip from the mandible, and improves dose homogeneity.Materials and methodsSeven patients with T2 lip cancer treated with a “sandwich” technique of High Dose Rate (HDR) brachytherapy to the lip, consisting of interstitial catheters and a customized mold with embedded catheters, were reviewed for dosimetry and outcome using 3D planning. Dosimetric comparison was made between the “sandwich” technique to “classic” – interstitial catheters only plan. We compared dose volume histograms for Clinical Tumor Volume (CTV), normal tissue “hot spots” and mandible dose. We are reporting according to the ICRU 58 and calculated the Conformal Index (COIN) to show the advantage of our technique.ResultsThe seven patients (ages 36–81 years, male) had median follow-up of 47 months. Four patients received Brachytherapy and External Beam Radiation Therapy, 3 patients received brachytherapy alone. All achieved local control, with excellent esthetic and functional results. All patients are disease free.The Customized Mold Sandwich technique (CMS) reduced the high dose region receiving 150% (V150) by an average of 20% (range 1–47%), The low dose region (les then 90% of the prescribed dose) improved by 73% in average by using the CMS technique. The COIN value for the CMS was in average 0.92 as opposed to 0.88 for the interstitial catheter only. All differences (excluding the low dose region) were statistically significant.ConclusionThe CMS technique significantly reduces the high dose volume and increases treatment homogeneity. This may reduce the potential toxicity to the lip and adjacent mandible, and results in excellent tumor control, cosmetic and functionality.
Highlights
Lip and oral cavity cancer is the 15th most common cancer worldwide, and the 15th most common cancer in Europe with more than 300,000 and around 61,400 new cases diagnosed in 2012 respectively [1]
The Customized Mold Sandwich technique (CMS) reduced the high dose region receiving 150% (V150) by an average of 20%, The low dose region improved by 73% in average by using the CMS technique
The CMS technique significantly reduces the high dose volume and increases treatment homogeneity. This may reduce the potential toxicity to the lip and adjacent mandible, and results in excellent tumor control, cosmetic and functionality
Summary
Lip and oral cavity cancer is the 15th most common cancer worldwide, and the 15th most common cancer in Europe with more than 300,000 and around 61,400 new cases diagnosed in 2012 respectively (in both cases 2% of the total) [1]. The incidence in Europe of oral cavity and pharynx cancer in 2012 was 99.6 per 100,000 [2]. Surgery or radiotherapy can be utilized, with similar local control and overall survival results [4,5,6]. Larger lesions may require wide resections with lip reconstruction, necessitating the use of flaps [7]. Cosmetic issues may result and more importantly disruption of the oral sphincter (orbicularis oris muscle), may lead to oral incompetence and in some cases to microstomia
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