TITLE:
Will High Dose Rate Interstitial Brachytherapy Be a Surrogate to Surgery in Early Mobile Squamous Cell Carcinoma of Tongue—An Indian Experience
AUTHORS:
Parthasarathy Vedasoundaram, K. S. Reddy, Gangotri Selvarajan, Saravanan Kandasamy, Mourougan Sinnathambi, Muzamil Asif, Vivekanandam Singhavajhala
KEYWORDS:
Tongue Cancer, High Dose Rate Interstitial Brachytherapy, Organ Preservation
JOURNAL NAME:
International Journal of Medical Physics, Clinical Engineering and Radiation Oncology,
Vol.3 No.3,
August
13,
2014
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.