REVIEW OF THE ROLE OF BRACHYTHERAPY IN THE MANAGEMENT OF ORAL CAVITY CANCERS

Abstract

From the day of invention of Radium, brachytherapy has been practised worldwide. Can any technological advancement in external beam radiotherapy replace brachytherapy? Answer probably no, especially in Gynaecological cancers as categorically stated by GEC-ESTRO experts. External beam radiation therapy using contemporary conformal techniques and brachytherapy play a signicant role in the management of oral cavity cancer. Small sized tumors in most of the oral cavity sites can be managed with brachytherapy alone either with intraoral cone or interstitial brachytherapy in order to minimize exposure of normal tissue. As these techniques do not treat regional lymph node basins, they are only appropriate to use as a single modality in selected stage I and II patients. The risk of occult nodal involvement in stage I and II is very low. External beam radiation therapy to the draining lymph node regions is used as the primary mode of irradiation when regional lymph nodes are at signicant risk for subclinical involvement, and brachytherapy may be added as a boost to the primary tumor. Since head and neck cancers are Surgeons domain, number of patients reporting to Radiation Oncology department is too low to carry out large randomized trial. Most of the patients report to Radiation Oncology department in either in late stage or in an early stage with poor general condition. This paves the way for selection bias and, of course, inferior results when compared with other modality. To evaluate the role of this therapy in treatment of head and neck cancers, we have reviewed its outcomes with oral cavity cancer. In conclusion, brachytherapy with or without EBRT can be an alternative to surgery in early and locally advanced oral cavity cancers although concrete evidence is yet to be produced with a sophisticated study in a reproducible manner