13 Head and Neck - Oropharynx

Head and Neck - Oropharynx

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THE GEC ESTROHANDBOOKOF BRACHYTHERAPY | Part II Clinical Practice Version 1 - 15/02/2021

TABLE 3 Studies of LDR brachytherapy for oropharyngeal cancer Author (year) Number of patients Site/ Stage Mode of treatment Total dose

Local control

Overall survival

Toxicity

Pernot M (1994)

Tonsil/soft palate/T1-T4 LDR

EBRT:50Gy+ BRT: 20-30Gy

361

5 yr: 80% 5 yr:53% STN:2.2% Gr 3-4, ORN Gr3: 2%

EBRT: 47Gy+/-4.3Gy+ BRT: 31Gy Radical BRT:64Gy+/- 2.9Gy

Mazeron JJ (1993)

Tonsil/soft palate/T1-T2

LDR, Guide gutter/ plastic tube

165

91% 5 yr: 60% STN: 20%

T1:85% T2:50% T3:69%

25% Mucosal necrosis, 1 carotid rupture Soft tissue necrosis or ORN: 11.4% 30% soft tissue necrosis, 3 ORN

Lusinchi A (1989) Puthawala A (1988)

EBRT:45Gy+ BRT: 43.8Gy

108

BOT/T1-T3 LDR/ Guide gutter, plastic tube

5 yr: 26%

EBRT: 45-50Gy+ BRT: T1-T2:20-25Gy T3-T4:30-40Gy EBRT: 48.6Gy (mean)+ BRT: 32Gy (mean)

70

BOT/T2-T4 LDR

83% 5 yr: 35%

Crook J (1988)

T1-85% T2-71%

2yr: 63% 5 yr: 50%

48

BOT/ T1, T2 LDR, guide gutter, plastic tube

Esche BA (1988) Regueiro C (1995)

Soft palate, uvula

LDR, guide gutter/ plastic tube

EBRT: 50Gy+ BRT: 20-35Gy

43

92% 3 yr: 60%

5 yr:37% 1 ORN, 3 STN

37

BOT/T1-4

LDR

EBRT: 50Gy+ BRT: 30Gy 67% 5 yr: 53% Soft tissue necrosis: 33%

TABLE 4 Studies of PDR and HDR brachytherapy for oropharyngeal cancers

Number of patients Site/ Stage Mode of treatment

Author (year)

Follow up Local control Overall

survival Toxicity

Grade 3 ulceration 3% >=grade 2 xerostomia 11% >=dysphagia 8%

EBRT-IMRT (Mean dose 46Gy) and PDR brachy (Mean dose 22.5Gy)

Al Mamgani et al (2013)

Oropharynx T1-3 N0-3

Median 56 months

5yr 94%

5 year 74%

167

EBRT (46Gy) +BT LDR-11 PDR-62 HDR-31 HDR: 3-4Gy/#

Tonsillar fossa/ soft palate

Levendag et al (2004)

Minimum 2 year

5year LC 88%

5year OS 67%

Ulcer in 39% Trismus 1%

104

EBRT+BRT Ext RT: Median 62.4Gy HDR BT: Median 24.5Gy 3-3.5Gy/# EBRT (45.8Gy) HFRT And PDR (median 35Gy) HDR alone-15 lesions (48 Gy/8#) EBRT (46 Gy) + HDR-21Gy 6Gy/# Surgery (84%) followed by PDR +/-EBRT Radical: Median dose 57Gy Boost: Median dose 24Gy EBRT (Mean 62Gy) And HDR (mean 17Gy) 3-4Gy/# EBRT (45-70Gy) HDR-median 16.8 Gy1.2- 5Gy/# BRT+/-EBRT Radical: 44.5Gy Boost:22.5Gy 3.5-4.5Gy/#

Soft tissue necrosis: 4 Tracheo-stomy dependence: 3 5 (6%) soft tissue necrosis, 6 (7%) osteoradio necrosis Transient soft tissue necrosis in 29%, No bone complications Soft tissue necrosis: 10.2% Bone necrosis: 4.9% 7 patients (12%) soft tissue necrosis, 1 patient osteoradionecrosis (1.5%)

88 (HDR 77, 11LDR)

Oropharynx- BOT T1-4, N0-2 Base of tongue T1-4 N0-2

Cano ER et al (2009)

Median 3.1 years 3 year 79.9% 3 year 80.9%

Johansson B et al (2011)

Median 46 months

5 yr 89%

5 year 65%

83

Nose et al (2004)

OPX T1-T4

Median 26 months

5year LC-82%

5year OS 64%

82

Oral cavity, oropharynx T1-3, N0-3

Strnad V et al (2013)

Median 63 months 5 year 85.8% 5 year 68.9%

79 of 385

Base of tongue T1-4 N0-3

Takacsi-Nagi Z et al (2013)

Mean 121 months

5yr 57%

5 year 47%

60

2year actuarial LC- 79% 6of 38 OPX had failures

For OPX ORN-4

OPX-39 OC-16 T1-T4

Rudoltz et al (1999)

Median FU 2.7 years

39 of 55

NA

Soft tissue necrosis-3

Oral cavity, Oropharynx T1-4, N0-2

Soft tissue necrosis: 2 Bone necrosis:1

Bhalavat R et al (2017)

Median 22 months Crude 70% 5yr 85.8%

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