ESTRO 2023 - Abstract Book

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ESTRO 2023

PO-2186 Does HDR brachytherapy for head and neck cancers still have a place in 2022 ?

J. Bouziane 1 , M. Ait Erraisse 1 , W. Hassani 1 , F.Z. Farhane 1 , Z. Alami 1 , T. Bouhafa 1

1 HASSAN II University Hospital, Radiation therapy, Fez, Morocco

Purpose or Objective Brachytherapy is an interesting irradiation technique for the management of head and neck cancers. After the heyday of the 1980s-1990s, brachytherapy has progressively lost its attractiveness, but the development of multimodal imaging, of new applicators adapted to tumors and of dose optimization processes, including hypofractionation possibilities, have led to an improvement of tumor control, and have led to revisit the indications of brachytherapy. This study evaluated the efficiency in terms of local control, survival and toxicity of irradiation of head and neck tumors by HDR brachytherapy. Materials and Methods We retrospectively reviewed the medical records of patients between January 2012 and August 2022, who received endocavitary or interstitial HDR brachytherapy as primary or salvage treatment for histologically proven head and neck cancer. Patients were indexed on the Hosix hospital network database, as well as the TPS ARIA, and were stratified according to age, sex, tumor location, technique and radiation dose. The data were processed using Excel software.Survival was estimated according to Kaplan-Meier curves and toxicity was graded according to the 4th version of the Common Terminology Criteria for Adverse Events CTCAE. Results Twenty-three patients underwent brachytherapy for their Head and neck cancer. The median age of our population was 51.5 years and the sex ratio M/F was 6.3. 14 tumors were located in the lower lip, one in the tongue, and 8 in the nasopharynx. For patients with squamous cell carcinoma of the lower lip;7 had exclusive brachytherapy and the others had postoperative brachytherapy because of close or positive margins. Only one patient of our study had exclusive brachytherapy for recurrent SCC of the tongue. 8 patients with non-metastatic recurrent undifferentiated nasopharyngeal carcinoma in an irradiated area were re-irradiated with brachytherapy for curative purpose. The median irradiation dose was 33.44 Gy on the reference isodose. With a median follow-up of 40.57 months, all patients were alive with complete remission, with no evidence of local or distant recurrence. 44% of patients had grade I radiodermatitis and no grade II-III toxicity occurred. Conclusion Brachytherapy is the most conformal irradiation technique allowing satisfactory cancer results; however, insufficient teaching, inadequate promotion, and an aging image of brachytherapy are the three major issues affecting its inclusion in the anticancer therapeutic arsenal. It’s essential that brachytherapy be re known in order to restore its value for patients who will be able to benefit from it in accordance with the indications specified during multidisciplinary concertation meetings. R. Vadgaonkar 1 , R. Miriyala 1 , A. Mehta 2 , C. Kiriti 1 , R. Hajare 1 , K.K. Sreelakshmi 1 , M. Anil Kumar 1 , S. Dash 1 , P. Parab 1 , N. Kumar 1 , R. Reddy 1 , S.R. Bulla 1 , V. Shende 1 , R. Biswas 1 , A. Nawar 1 , K. Gunjal 1 , S. Ghagre 1 , C. Dravid 3 , S.K. Kavutarapu 3 , U. Mahantshetty 1 1 Homi Bhabha Cancer Hospital and Research Centre, Radiation Oncology, Visakhapatnam, India; 2 Homi Bhabha Cancer Hospital and Research Centre , Radiation Oncology, Visakhapatnam, India; 3 Homi Bhabha Cancer Hospital and Research Centre, Surgical Oncology, Visakhapatnam, India Purpose or Objective Interstitial brachytherapy (ISBT) is considered one of the standard modalities for curative treatment of early stage oral cancers. However, optimal utilization of this modality in the era of multidisciplinary cancer care can be challenging, especially in a newly commissioned comprehensive cancer centre. We present our experience and challenges in implementing ISBT for head neck cancers and early outcomes of oral tongue cancer treated with ISBT in the first two years of commissioning the brachytherapy services. Materials and Methods ISBT services were commissioned in August 2020 at our institution. Challenges faced during implementation of ISBT in head and neck cancers were enumerated. Case records of all early stage head and neck cancer patients treated at our institution with ISBT between September 2020 and September 2022 were retrospectively reviewed. Results The technical challenges included commissioning of the Cobalt after-loader, dedicated brachytherapy procedure room, setting up of BT applicator sets (implantation kit, nylon tubes, beads etc.), orientation and training of ancillary staff. Though incidence of HN cancers is high, proportion of patients deemed suitable for BT was low, due to advanced stage at presentation (Table 1). Multidisciplinary tumor board consultation before treatment initiation is quintessential for identifying patients who can potentially benefit from BT. Discussing organ preservation approaches with patients also helped increase BT utilization, especially for tongue cancer. Among the 14 patients with tongue cancer, median tumor size was 2 cm, and clinical stage was T1 in 10 and T2 in 4 patients. All patients received prophylactic irradiation to bilateral neck nodes along with primary, using VMAT (50Gy/25#/5 weeks), followed by HDR Interstitial BT boost by CT based planning after a median gap of 22 days (range, 15-42 days). Most patients required implantation in two planes, with 9 to 15 catheters (median, 11). Median BT prescription dose was 22.5 Gy in 5 PO-2187 Challenges in implementing brachytherapy for head & neck cancer in a New Comprehensive Cancer Centre