title: A case-control study of patients with squamous cell carcinoma of the oral cavity and oropharynx treated with pulsed-dose-rate brachytherapy.
abstract: OBJECTIVE
  Pulsed-dose-rate (PDR) brachytherapy is thought to mimic the radiobiological benefits of continuous low-dose-rate (cLDR) delivery but is safer for medical personnel. We set out to evaluate the outcomes of this technique in patients with head and neck squamous cell carcinoma.
  
  
  METHODS
  A total of 36 consecutive patients treated with PDR brachytherapy were randomly matched to 72 cLDR controls according to T-stage, tumor site, and management strategy. Local recurrence and late complications were compared between the two groups.
  
  
  RESULTS
  Baseline characteristics were similar in both groups. Oral cavity cancers predominated at 81%, and 89% had T1/T2 tumors. Seventy-five percent of patients underwent surgery before radiation treatment. Median followup was 59 and 30 months for cLDR and PDR patients, respectively. Three-year actuarial local recurrence-free survival was 97% and 94% for cLDR and PDR patients, respectively (p = 0.77). Three-year cumulative risk of Grade ≥2 complications was 45% and 32% for cLDR and PDR patients, respectively (p = 0.2). For cLDR, a dose rate exceeding 68 cGy/h resulted in more complications (RR 5.3, p < 0.05). Similarly, PDR patients receiving ≥75 cGy/pulse were at higher risk.
  
  
  CONCLUSIONS
  PDR brachytherapy in head and neck squamous cell carcinoma yields comparable results to cLDR treatment. Dose rate was correlated with the risk of late complications, regardless of technique.
authors.affiliation: Département de Radiothérapie, Centre Alexis Vautrin, Vandoeuvre-lès-Nancy, France. Electronic address: ahaddad@toh.on.ca.
authors.forename: Alain
authors.initials: A
authors.lastname: Haddad
authors.affiliation: Département de Radiothérapie, Centre Alexis Vautrin, Vandoeuvre-lès-Nancy, France.
authors.forename: Didier
authors.initials: D
authors.lastname: Peiffert
authors.affiliation: Département de Radiothérapie, Centre Jean Perrin, Clermont-Ferrand, France.
authors.forename: Michel
authors.initials: M
authors.lastname: Lapeyre
authors.affiliation: Unité d'Activité et de Statistiques Médicales, Centre Alexis Vautrin, Vandoeuvre-lès-Nancy, France.
authors.forename: Valentin
authors.initials: V
authors.lastname: Harter
authors.affiliation: Département de Physique, Centre Alexis Vautrin, Vandoeuvre-lès-Nancy, France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Buchheit
authors.affiliation: Département de Radiothérapie, Centre Alexis Vautrin, Vandoeuvre-lès-Nancy, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Graff
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000379:methods*; D002294:Carcinoma, Squamous Cell / Q000532:radiotherapy*; D016022:Case-Control Studies; D002985:Clinical Protocols; D019583:Dose Fractionation, Radiation; D005260:Female; D006258:Head and Neck Neoplasms / Q000532:radiotherapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000532:radiotherapy*; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control / Q000532:radiotherapy; D009959:Oropharyngeal Neoplasms / Q000532:radiotherapy*; D011879:Radiotherapy Dosage; D000077195:Squamous Cell Carcinoma of Head and Neck
keywords: Brachytherapy; Head and neck; PDR