Adjuvant interstitial three-dimensional pulse-dose-rate-brachytherapy for lip squamous cell carcinoma after surgical resection

Abstract

Purpose The purpose of this study was to report clinical outcomes of patients treated with pulse-dose-rate brachytherapy (PDR-BT) for lip cancer after insufficient surgery. Material and methods Twenty lip cancer patients were treated from January 2012 to September 2016. Primary treatment included surgery with or without reconstruction. All patients were diagnosed with squamous cell carcinoma, most of the tumors were pT1. Brachytherapy procedures were done after post-operative wound healing. Median of three plastic tubes were implanted using a free-hand technique. Two PDR-BT treatments were scheduled for every patient, with the gap of median 13 days. The planned dose was 0.8-1 Gy per pulse to the total dose of 50 Gy from two PDR-BT treatments. Patients were evaluated every 3-6 months. Follow-up time was counted from the last day of treatment to any event or last visit. Early and late toxicities were scored with RTOG scale. Results Average follow-up was 34.7 months (range, 12.7-67.6). Three- and five-year estimated disease-free survival was 95% and local control was 100%. One patient suffered from regional relapse in the submental region (IA lymph node group). Skin erythema or dry desquamation (grade 1) or wet desquamation (grade 2) was observed in 13 patients (65%) and one patient (5%), respectively. Six patients presented no acute toxicity. Moreover, there were no complications involving lip mucosa. All patients had grade 1 soft tissue fibrosis in the irradiated area, besides that, late toxicity included only skin complications. There were no significant factors associated with late toxicity ≥ grade 2. Conclusions PDR-BT in the adjuvant treatment of the lip cancer yields high local control with low toxicity. Even patients with close margins after surgery (< 5 mm) should be considered as candidates for PDR-BT.

A Systematic Review of Primary, Adjuvant, and Salvage Radiation Therapy for Cutaneous Squamous Cell Carcinoma

“…Nineteen studies with a total of 956 tumors (23.1%) were treated with a combination of primary radiation, surgery, and adjuvant/salvage RT 6,9,13,19,20,27,28,30,40–42,44,46–50,55,56 (See Supplemental Digital Content 4 , Table 5, http://links.lww.com/DSS/A713). Of these, 13 studies provided data on tumor stage: 161/496 (32%) of tumors were staged T1, 74/496 (15%) T2, 249/496 (50%) T3, and 12/496 (2%) T4 (See Supplemental Digital Content 2 , Table 2, http://links.lww.com/DSS/A710).…”

“…The main indications for adjuvant RT were PNI in 11 studies 6,9,20,27,28,30,42,46–48,56 and positive margins or recurrent tumors in 8 studies 13,19,30,41,44,49,50,55 (See Supplemental Digital Content 2 , Table 5, http://links.lww.com/DSS/A713). Most studies did not differentiate between adjuvant and salvage RT nor delineate outcomes based on treatment type (i.e., adjuvant/salvage RT vs surgery monotherapy vs radiation monotherapy).…”

“…Three hundred fifty-three (8.5%) tumors were characterized as having PNI. Nine studies, consisting of 365 tumors, commented on histologic grade 6,9,13,27,30,42,43,47,49 : 61 tumors were well differentiated (1.5%), 175 moderately differentiated (4.2%), and 129 poorly differentiated (3.1%). The AJCC eighth edition staging system was used to stage tumors, if data was extractable.…”

“…Only one radiation monotherapy study provided data on tumor differentiation: 39/59 (57%) tumors were well differentiated, 28/59 (41%) were moderately differentiated, and 2/59 (3%) were poorly differentiated. 44 Nineteen studies with a total of 956 tumors (23.1%) were treated with a combination of primary radiation, surgery, and adjuvant/salvage RT 6,9,13,19,20,27,28,30,[40][41][42]44,[46][47][48][49][50]55,56 (See Supplemental Digital Content 4, Table 5, http:// links.lww.com/DSS/A713). Of these, 13 studies provided data on tumor stage: 161/496 (32%) of tumors were staged T1, 74/496 (15%) T2, 249/496 (50%) T3, and 12/496 (2%) T4 (See Supplemental Digital Content 2, Table 2, http://links.lww.com/DSS/A710).…”

High-dose-rate brachytherapy (interventional radiotherapy) in lip carcinoma with rigid needles: a simple technique with excellent results

“…Indications for treating lip carcinoma with HDR are described in recommendations for head and neck BT [12]. Pulsed-dose-rate (PDR) BT using plastic tubes or needles has also shown good results [13][14][15][16]. Several publications described the use of moulds to treat small lip carcinomas [17][18][19][20]; however, the interstitial implantation of rigid needles or plastic tubes is the current standard practice (interventional radiotherapy).…”