Long term results from a uniform clinical series on pulsed dose rate brachytherapy as the boost to external beam irradiation in base of tongue cancer

• Background and purpose: To evaluate the long time outcome with regard to local tumour control, side effects and quality of life of a combined pulsed dose rate (PDR) boost and hyperfractionated accelerated external beam radiotherapy (EBRT) for primary base of tongue (BOT) cancers.Patients and methods: Between 1994 and 2007 we treated 83 patients, median age 60 (38-82) years, with primary T1-T4 BOT cancers. Seven patients (8 %) were T1-2N0 (AJCC stage I-II) and 76 (92 %) patients were T1-2N+ or T3-4N0-3 (AJCC stage III-IV). The mean estimated primary tumour volume was 15 (1-75) cm3.  EBRT was given with 1.7 Gy twice daily to 40,8 Gy to primary tumour and bilateral neck lymph nodes in 2.5 weeks. A PDR boost of 35 Gy and a neck dissection in clinical node positive cases was performed 2-3 weeks later. The patients were followed for a median of 54 (2-168) months.Results: The 2-, 5- and 10-years rates of actuarial local control were 91 %, 89 % and 85 %, overall survival 85 %, 65 % and 44 %, disease free survival 86 %, 80 % and 76 % respectively. The regional contral rate was 95 %. Six patients (7 %) developed distant metastases. Analysis of dosimetry showed a mean treated volume of 58 cm3.  In a review of late complications we found 11 (13 %) minor and 4 (5 %) major soft tissue necroses and 6 (7 %) osteoradionecroses. The patients median subjective SOMA/LENT scoring at last follow up was; grade 0 for pain and trismus, grade 1 for dysphagia and taste alteration and grade 2 for xerostomia. Global visual-analog-scale (VAS) scoring of quality of life was 8.Conclusions: Local and regional tumour control rate was excellent in this treatment protocol. The data support that PDR boost is at least as effective as published continuous low dose rate (CLDR) results.

Subject headings

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Cancer och onkologi (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Cancer and Oncology (hsv//eng)

Keyword

Brachytherapy; Pulsed dose rate; Base of Tongue cancer; Outcome; Radio-therapy

Oncology

Onkologi

Onkologi

Oncology

Publication and Content Type

vet (subject category)

ovr (subject category)