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

Johansson et al studied 83 patients with base of tongue cancers treated between 1994-2007 with EBRT and PDR BT [33]. EBRTwas delivered using a hyperfractionated schedule to a dose of 40.8Gy in 2.5 weeks using 1.7Gy bid fractionation. After the implantation patients received PDR BT to a dose of 35Gy in 12 pulses over 2.5 days. At a median follow up of 46months they reported actuarial 2, 5 and 10 year LC of 91%, 89% and 85%. Actuarial DFS at 2, 5 and 10 years were 86%, 80% and 70% while OAS was 85%,65% and 44%. They reported soft tissue necroses in 5 (6%) patients and osteoradionecrosis in 6 (7%) patients. Strnad V et al reported their experience of 385 patients of head neck cancers of which 79 had oropharyngeal primary [12]. Patients were treated with either PDR BT alone or in combination with EBRT. The median dose of radical BT was 57Gy while it was 24 Gy for boost BT. They reported a 5 year LC rate of 85.8% and OAS of 67.9% for the entire group. Soft tissue necrosis was observed in 10.2% while bone necrosis was seen in 4.7% in the entire group. The control rates and toxicity specifically related to oropharyngeal cancers have not been documented. HDR There is limited data on the use of HDR BT for oropharyngeal cancers (Table 4).

Mohanti et al compared 84 patients treated with HDR BT for head neck cancer to their earlier series of LDR BT. Amongst 84 patients oropharyngeal primary was observed in only 14 patients. At a median follow up of 14 months they observed 5 year LC rate of 62% and DFS of 52% which was comparable to their LDR series [46].Thus results of HDR BT are comparable with LDR BT. Cano et al studied 88 patients of base of tongue cancer who were treated with combined chemoradiation followed by BT [37]. Patients received EBRT to a median dose of 62Gy. HDR BT was used in 77 patients while LDR was used in 11 patients. With the median follow up of 3.1 years they observed 3 year LC of 79.9% andOAS of 80.9%with soft tissue necrosis in 4 patients. All patients routinely had a tracheostomy which was closed after the procedure. However three patients remained dependent on tracheostomy. Nose et al studied 82 patients with 83 oropharyngeal malignancies [47] . Patients were treated with EBRT to a median dose of 46Gy followed by HDR BT. The dose of HDR for the radical setting was 48Gy/8 fractions/5 days and for a boost BT it was 21Gy/3.5 fractions/2 days. At a median follow up of 26 months, 5 year LC was 82% and OAS was 64%. They observed 29% soft tissue necrosis. Six patients required hyperbaric oxygen therapy while 1 patient required surgery for soft tissue necrosis. There was no bony complication in their series.

Figure 29: Pre and post treatment clinical photographs of a patient with T1 tumour of the soft palate and uvula treated with radical brachytherapy.

Figure 30: Pre and Post EBRT+ Brachytherapy clinical photographs of a patient with carcinoma of Rt tonsil showing organ and function preservation with brachytherapy