title: From low-dose-rate to high-dose-rate brachytherapy in lip carcinoma: Equivalent results but fewer complications.
abstract: OBJECTIVE
  To compare the use of high-dose-rate (HDR) brachytherapy (BT) in patients with lip carcinoma with a former series previously treated with low-dose-rate (LDR) BT.
  
  
  METHODS
  Ninety-nine patients treated with LDR-BT were compared with 104 patients treated with HDR-BT. Distribution by stage was 53.5% T1, 15.1% T2, 3.1% T3, and 28.3% T4 for LDR and 52.9% T1, 32.7% T2, 0% T3, and 14.4% T4 for HDR. Some cases with positive or close margins received BT after surgery (34.3% with LDR vs. 16.3% with HDR). Parallel metallic needles were used in 100% of HDR cases and in 76% of LDR cases. Most HDR patients were treated with HDR-BT to a dose of 4.5-5 Gy per fraction prescribed to a 90% isodose, in nine fractions delivered twice daily for 5 days.
  
  
  RESULTS
  Median followup was 63 months for LDR-BT and 51 months for HDR-BT. Overall local control for LDR- vs. HDR-BT was 94.9% vs. 95.2%; and 100% vs. 100%, 86.6% vs. 94.1%, and 89.3% vs. 80%, for T1, T2, and T4 stage tumors, respectively. Disease-free survival for LDR vs. HDR was 95.9% vs. 94.2%. Soft tissue necrosis, bone necrosis, and fair-bad cosmesis for LDR vs. HDR was 15.1% vs. 0%, 1% vs. 0%, and 11.1% vs. 0%, respectively.
  
  
  CONCLUSIONS
  Treatment with HDR-BT using rigid needles is a simple technique that provides good long-term results with minimal complications. LDR- and HDR-BT are regarded as equally effective in local control and disease-free survival, but fewer complications arise when using HDR-BT.
authors.affiliation: Department of Radiation Oncology, Fundacion Instituto Valenciano de Oncologia (I.V.O.), Valencia, Spain. Electronic address: jguinot@fivo.org.
authors.forename: Jose-Luis
authors.initials: JL
authors.lastname: Guinot
authors.forename: Leoncio
authors.initials: L
authors.lastname: Arribas
authors.forename: Maria Isabel
authors.initials: MI
authors.lastname: Tortajada
authors.forename: Vicente
authors.initials: V
authors.lastname: Crispín
authors.forename: Maria
authors.initials: M
authors.lastname: Carrascosa
authors.forename: Miguel
authors.initials: M
authors.lastname: Santos
authors.forename: Alejandro
authors.initials: A
authors.lastname: Mut
authors.forename: Juan Bosco
authors.initials: JB
authors.lastname: Vendrell
authors.forename: Carmen
authors.initials: C
authors.lastname: Pesudo
authors.forename: Maria Luisa
authors.initials: ML
authors.lastname: Chust
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000009:adverse effects / Q000379:methods*; D018572:Disease-Free Survival; D004307:Dose-Response Relationship, Radiation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008048:Lip Neoplasms / Q000401:mortality / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D011832:Radiation Injuries / Q000453:epidemiology; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D013030:Spain / Q000453:epidemiology; D015996:Survival Rate
keywords: Brachytherapy; Complications; High dose rate; Lip carcinoma; Local control; Low dose rate