title: Interstitial brachytherapy with or without external beam irradiation in head and neck cancer: Institute Rotary Cancer Hospital experience.
abstract: Iridium-192 interstitial brachytherapy is practiced infrequently in developing countries, even where head and neck cancer is a major neoplasm and the technique could provide good results. This report from India is presented as an audit to validate the benefit of brachytherapy. One hundred and six head and neck cancer patients were treated by interstitial brachytherapy alone (n = 29) or combined with external irradiation (n = 77). The oral cavity and the oropharynx together constituted 82% of the sites of implanted tumours; 75% were T(1-2)N0 status. Brachytherapy was carried out using afterloaded plastic catheters and the Paris dose prescription system was followed. External cobalt-60 beam portals covered the primary and the neck. The median duration of follow-up was 22 months. The median dose of brachytherapy used alone was 60 Gy. With combined treatment, the median external radiotherapy and brachytherapy doses were 50 Gy and 25 Gy respectively. The median brachytherapy dose rate was 0.5 Gy/h. Primary and nodal recurrences were recorded in 41/106 (38.7%) and 18/106 (17.0%) patients at median intervals of 15 and 13 months respectively. Implant site failure was more common after combined treatment than with brachytherapy alone (42.8% versus 27.5%), but it did not reach statistical significance in this analysis (P = 0.15). Kaplan-Meier actuarial 5-year estimates showed 52% and 87% disease-free and overall survivals. Iridium-192 interstitial implants in suitably selected head and neck cancer patients can improve the radiotherapeutic results, with the promise of organ conservation in 50%. In India, the practice should be established in more radiotherapy centres and could be utilized in 10,000-25,000 head and neck cancer patients annually.
authors.affiliation: Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi.
authors.forename: B K
authors.initials: BK
authors.lastname: Mohanti
authors.forename: M
authors.initials: M
authors.lastname: Bansal
authors.forename: S
authors.initials: S
authors.lastname: Bahadur
authors.forename: N K
authors.initials: NK
authors.lastname: Shukla
authors.forename: S V
authors.initials: SV
authors.lastname: Deo
authors.forename: R
authors.initials: R
authors.lastname: Prabhakar
authors.forename: G K
authors.initials: GK
authors.lastname: Rath
mesh_terms: D000328:Adult; D000368:Aged; D001918:Brachytherapy; D002294:Carcinoma, Squamous Cell / Q000532:radiotherapy*; D016371:Cranial Irradiation; D005260:Female; D006258:Head and Neck Neoplasms / Q000532:radiotherapy*; D006801:Humans; D007194:India; D007496:Iridium Radioisotopes / Q000627:therapeutic use*; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D015996:Survival Rate; D013997:Time Factors
chemical_list: D007496:Iridium Radioisotopes