title: Long-term outcomes with high-dose-rate brachytherapy for the management of base of tongue cancer.
abstract: OBJECTIVE
  To report the long-term results of a prospective, nonrandomized clinical trial using high-dose-rate (HDR) brachytherapy (BT) for the management of base of the tongue (BOT) tumors.
  
  
  METHODS
  Between January 1992 and June 2011, 60 patients (mean age, 57 years; range, 36-78 years) with T1-T4 and N0-3 carcinoma of BOT were treated. Fifty-six patients (93%) had advanced (Stage III-IV) disease. HDR BT boost (mean dose, 17 Gy; range, 12-30 Gy) was delivered after 50-70 Gy (mean 62 Gy) locoregional external beam irradiation. Seventeen patients (28%) received radiochemotherapy (RCT) with cisplatin.
  
  
  RESULTS
  The 5-year actuarial rate of local tumor control, locoregional tumor control, overall survival (OS), and cancer-specific survival (CSS) was 57%, 50%, 47%, and 61%, respectively. OS was significantly better in patients (n=17) receiving RCT (69% vs. 39%; p=0.005). Delayed soft-tissue ulceration occurred in seven patients (12%). Only one patient (<2%) developed osteoradionecrosis. In univariate analysis, the tumor size (T1-T2-T3 vs. T4) was found to have a significant effect on CSS (p=0.043), whereas the nodal status (N0 vs. N+) affected locoregional tumor control (p=0.042), OS (p=0.002), and CSS (p=0.015). Low histologic grade (1-2) was associated with better CSS (p=0.020), whereas RCT significantly improved OS (p=0.012).
  
  
  CONCLUSIONS
  External beam irradiation combined with interstitial HDR BT boost results in good local tumor control with an acceptable rate of late side effects in patients with BOT carcinoma. RCT improves OS. Our results are similar to those reported with traditional low-dose-rate BT implants.
authors.affiliation: Center of Radiotherapy, National Institute of Oncology, Budapest, Hungary. Electronic address: takacsi@oncol.hu.
authors.forename: Zoltán
authors.initials: Z
authors.lastname: Takácsi-Nagy
authors.forename: Ferenc
authors.initials: F
authors.lastname: Oberna
authors.forename: Pál
authors.initials: P
authors.lastname: Koltai
authors.forename: Erika
authors.initials: E
authors.lastname: Hitre
authors.forename: Tibor
authors.initials: T
authors.lastname: Major
authors.forename: János
authors.initials: J
authors.lastname: Fodor
authors.forename: Csaba
authors.initials: C
authors.lastname: Polgár
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy; D001918:Brachytherapy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006814:Hungary / Q000453:epidemiology; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors; D014062:Tongue Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*
keywords: Base of tongue; Brachytherapy; HDR