Brachytherapy or stereotactic body radiotherapy boost for early-stage oropharyngeal cancer: comparable outcomes of two different approaches.
OBJECTIVE
To compare outcome, toxicity and QoL of two boost modalities for T1-2 oropharyngeal carcinoma (OPC).


METHODS
Between 2000 and 2012, 250 consecutive patients with T1-2N0-3 were treated with 46-Gy of IMRT followed by boost using brachytherapy (BTB) or stereotactic body radiotherapy (CKB). Endpoints were local control (LC), disease-free survival (DFS), overall survival (OS), toxicity and prospective QoL-assessment.


RESULTS
The 3-year actuarial incidence of LC were 97% and 94% for the CKB and BTB, respectively (p=0.33). The figures for DFS were 92% and 86% (p=0.15) and for OS were 81% and 83% (p=0.82), respectively. The incidence of tube feeding were 17% and 20%, respectively (p=0.47). The figures for grade ⩾2 late dysphagia were 11% and 8% (p=0.34) and for xerostomia were 16% and 12% (p=0.28), respectively. For both modalities, clinically relevant deteriorations were seen on all scales at end of treatment but the scores returned to almost baseline levels within 6-12months, with exception of QLQ-H&N35-xerostomia. The difference on that scale was neither statistically significant nor clinically relevant between both modalities.


CONCLUSIONS
Comparable outcome, toxicity and QoL-scores were achieved with both modalities. In the light of the logistical hassle around the implantation, the need of dexterity, and the risk of anaesthesia and peri-operative complications associated with BTB, CKB might be regarded as the optimal option to boost early-stage OPC. However, in radiotherapy departments where no facilities are available for stereotactic radiotherapy, BTB is an elegant option to achieve excellent outcome with low toxicity profile and good QoL.
Departments of Radiation Oncology, Erasmus MC-Daniel den Hoed Cancer Center, Rotterdam, The Netherlands. Electronic address: a.al-mamgani@erasmusmc.nl.
Abrahim
A
Al-Mamgani
Peter
P
Van Rooij
Aniel
A
Sewnaik
Robert
R
Mehilal
Lisa
L
Tans
Gerda M
GM
Verduijn
Robert J
RJ
Baatenburg de Jong
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000009:adverse effects*; D003680:Deglutition Disorders / Q000209:etiology; D018572:Disease-Free Survival; D004750:Enteral Nutrition; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009959:Oropharyngeal Neoplasms / Q000532:radiotherapy*; D011446:Prospective Studies; D011788:Quality of Life; D016634:Radiosurgery / Q000009:adverse effects*; D016896:Treatment Outcome; D014987:Xerostomia / Q000209:etiology
Brachytherapy; Cyberknife; Oropharyngeal cancer; Quality of life; Stereotactic body radiotherapy