Abstract
BackgroundThe study aimed to assess the effect of High Dose Rate (HDR) Interstitial Brachytherapy when used alone or in combination with External Beam Radiotherapy (EBRT), in early and locally advanced squamous cell carcinoma of buccal mucosa.Materials and methodsThirty three patients with histologically proven squamous cell carcinoma of the buccal mucosa received high dose rate interstitial brachytherapy either as primary treatment or as a boost from November 2008 to April 2013. Stage I patients received interstitial brachytherapy alone to a dose of 38.50 Gy, 3.5 Gy per fraction, twice daily at six hours apart for 11 fractions. Stage II patients received EBRT to a dose of 50 Gy in 25 fractions of two Gy each followed by brachytherapy boost to 21 Gy, 3.5 Gy per fraction, twice daily at six hours apart for six fractions. Stage III patients received the same radiotherapy schedule (i.e., same EBRT & Brachytherapy schedule) and with addition of Injection Cisplatin 70 mg/m2 in three divided doses every three weeks along with EBRT.ResultsFollow up ranged from 12 to 60 months, median follow up was 26 months. Complete response was observed in 28 patients. Five patients had residual disease and were referred for surgical salvage. One patient died of disease progression. Stage I patients had 100% local control, whereas Stage II and Stage III patients had 84.6% and 80% local control respectively.ConclusionHDR Interstitial Brachytherapy used either as a primary treatment modality or as a boost in buccal mucosal cancers provides results comparable to that of surgery, with the advantages of organ preservation, better cosmetic and functional outcomes.
Highlights
Brachytherapy has been used in the management of cancers since the advent of radiotherapy as a treatment modality in Oncology
External Beam Radiotherapy (EBRT) with High Dose Rate (HDR) brachytherapy boost has been shown to provide better local control rates compared to external beam radiation alone in locally advanced oral cavity cancers (Donath et al 1995)
Concurrent chemo radiation with Injection Cisplatin has proven its superiority over radiotherapy alone in locally advanced head and neck cancers (Studer et al 2007)
Summary
It has proven its utility in the treatment of localized tumors with its ability to provide high doses to the target volume while sparing the surrounding normal tissues due to its rapid dose fall-off. This has enabled brachytherapy to be an efficient and cost effective form of Surgery has been the primary modality of treatment in early T1 &T2 buccal mucosal cancers. The study aimed to assess the effect of High Dose Rate (HDR) Interstitial Brachytherapy when used alone or in combination with External Beam Radiotherapy (EBRT), in early and locally advanced squamous cell carcinoma of buccal mucosa
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