Role of interstitial PDR brachytherapy in the treatment of oral and oropharyngeal cancer. A single-institute experience of 236 patients.
OBJECTIVE
To evaluate the role of pulsed-dose-rate interstitial brachytherapy (PDR IBT) in patients with head-and-neck malignancies.


METHODS
From October 1997 to December 2003, 236 patients underwent PDR IBT for head-and-neck cancer at the authors' department. 192 patients received brachytherapy as part of their curative treatment regimen after minimal non-mutilating surgery, 44 patients were treated with irradiation alone. 144 patients had sole IBT (median D(REF) = 56 Gy), in 92 patients IBT procedures (median D(REF) = 24 Gy) were performed in combination with external irradiation. The pulses (0.4-0.7 Gy/h) were delivered 24 h a day with a time interval of 1 h between two pulses. The analysis of tumor control, survival and treatment-related toxicity was performed after a median follow-up of 26 months (6-75 months).


RESULTS
At the time of analysis permanent local tumor control was registered in 208 of 236 patients (88%). At 5 years overall survival and local recurrence-free survival of the entire group were 82-73% and 93-83% for T1/2, and 56% and 83% for T3/4, respectively. Soft-tissue necrosis was seen in 23/236 patients (9.7%) and bone necrosis in 17/236 patients (7.2%). No other serious side effects were observed.


CONCLUSIONS
PDR IBT with 0.4-0.7 Gy/h and 1 h between pulses is safe and effective. These results confirm that PDR IBT of head-and-neck cancer is comparable with low-dose-rate (LDR) brachytherapy - equally effective and less toxic.
Strnad
Vratislav
V
Department of Radiation Oncology, University Erlangen-Nuremberg, Erlangen, Germany. vstrnad@strahlen.imed.uni-erlangen.de
Melzner
Winfried
W
Geiger
Matthias
M
Zenk
Johannes
J
Waldfahrer
Frank
F
Lotter
Michael
M
Ott
Oliver
O
Seeger
Annedore
A
Iro
Heinrich
H
Sauer
Rolf
R
D001918:Brachytherapy / Q000379:methods / Q000706:statistics & numerical data*; D015897:Comorbidity; D018572:Disease-Free Survival; D005858:Germany / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D009062:Mouth Neoplasms / Q000401:mortality* / Q000532:radiotherapy*; D009959:Oropharyngeal Neoplasms / Q000401:mortality* / Q000532:radiotherapy*; D011379:Prognosis; D011832:Radiation Injuries / Q000401:mortality*; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D017695:Soft Tissue Injuries / Q000401:mortality*; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome