Abstract
The study was intended to highlight functional outcome and survival advantage when High Dose Rate (HDR) interstitial implant was used for anterior 2/3rd tongue, either as a primary or as boost depending upon stage of disease. Materials and Methods: Fifty-one patients with squamous cell carcinoma of anterior 2/3rd tongue received interstitial brachytherapy either as primary or as boost with Iridium 192 remote after loading high dose rate (Microselectron or Gamma MediX) machines from November 2008 to September 2013. Age group ranged from 32 to 73 years, mean 52.1. Of these 51, 37 were males and 14 were females. 8 patients belonged to Stage I, 18 from Stage II and 28 patients were Stage III. Stage I patients received primary brachytherapy alone of dose 38.50 Gy to 40 Gy and fraction dose ranged from 250 cGy to 350 cGy. Stage II and Stage III patients received external beam radiation of dose 44 Gy/200cGy per fraction for 22 fractions followed by spinal cord sparing for 6 Gy/200cGy per fraction for 3 fractions. Brachytherapy boost of dose 21 Gy was delivered after external beam radiation. Stage III patients received concurrent chemotherapy with Injection Cisplatin along with external beam radiotherapy 44 Gy/200cGy per fraction for 22 fractions followed by spinal cord sparing for 6 Gy/200cGy per fraction for 3 fractions. Brachytherapy boost of dose 21 Gy was delivered after external beam radiation. 55% of patients were habituated to tobacco and alcohol in one form or the other or both. Surprisingly 45% of patients were nonsmokers and non-alcoholic. Results: Follow-up period ranged from eight months to sixty months. 42 patients had complete response. 9 patients had residual disease. 2 patients died due to non-cancerous cause though they had excellent local control, one with pulmonary tuberculosis and the other with massive Myocardial Infarction. 2 patients died due to disease progression. Overall complete response rate was 82.35%. Those patients who had good coverage index and conformal index had good response compared to those patients with lesser these values. Conclusion: It is surprising to observe from the study that oral cavity cancers are not uncommon in non-smokers and non-alcoholics. Overall complete response of 82% is comparable to any other study quoted in literature. Surgery offers same cure rate but at the rate of organ loss and functional impairment. Organ preservation with good functional outcome is possible in radiotherapy unlike surgery. This study proves brachytherapy can be considered as a surrogate to surgery in early stage tongue cancers with good functional outcome and with lesser morbidity.
Highlights
Despite oral cavity cancer remains more prevalent and accessible site, treatment and survival still remains enigma
This study proves brachytherapy can be considered as a surrogate to surgery in early stage tongue cancers with good functional outcome and with lesser morbidity
From November 2008 to September 2013, 51 patients with early tongue lesions with squamous cell carcinoma treated with High Dose Rate (HDR) Iridium192 brachytherapy either as primary or boost were evaluated for the response and toxicity
Summary
Despite oral cavity cancer remains more prevalent and accessible site, treatment and survival still remains enigma. It often eludes the treating surgeons and physicians despite technological strides and safe surgical procedure. No breakthrough occurred in survival rate for oral cancers in recent past in less developed countries [1]-[3]. About 90% of oral cavity cancers are squamous cell carcinoma and nodal metastasis range from 15% to 75% depending on the size of the primary lesion [3]-[5]. 5-year survival rate can be as high as 72% to 90% for patients without lymph node metastasis but devolves to 50% with node positivity [8] Frequency of nodal metastasis always dictates prognosis and survival [6] [7]. 5-year survival rate can be as high as 72% to 90% for patients without lymph node metastasis but devolves to 50% with node positivity [8]
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