Brachytherapy in head and neck malignancies: Indian Brachytherapy Society (IBS) recommendations and guidelines

Abstract

Purpose Brachytherapy (BT) forms major treatment modality in squamous cell carcinoma of head and neck cancers (HNC). However, there is a dearth of literature and guidelines for the use in various indications. High-dose-rate brachytherapy (HDR-BT) in Indian scenario is an important treatment modality, and the recommendations in this guidelines aim to provide the necessary recommendations for the use of HDR-BT for uniform application across the country in patients with HNC. Material and methods A panel consisting of members of the Indian Brachytherapy Society (IBS), based on their clinical experience was invited. The process involved defining important steps, precautions, target volumes and indications, thorough literature review, and discussion with fellow members. The guidelines were established and formulated the recommendations for HDR-BT based on available evidences and individual experience for sites, relevant to Indian settings. Results The IBS recommends the use of HDR brachytherapy as a part of treatment of head and neck tumors. The scope of these guidelines and recommendations included practical suggestions, ensuring efficient use of brachytherapy treatment as radical with external beam radiotherapy (EBRT) boost, palliative and adjuvant as definitive, or re-radiation as salvage for HNC in India. The IBS has made specific site-wise recommendations for previously untreated and recurrent HNC patients on their selection criteria, implant techniques, target volume definition, and HDR treatment parameters, such as time, dose rate, total dose, and fractionation schedules. Limited experience exists with HDR-BT in patients with head and neck cancers in India and across the globe. Conclusions IBS provided a consensus statement and guidelines for the head and neck brachytherapy and believed that these recommendations will overcome the fear of practicing radiation oncologists. This should generate interest amongst students and will help radiation oncologists all across the country to use the art of brachytherapy carefully in HNC patients, with better curative and salvage options.

Interventional Radiotherapy (Brachytherapy) for Nasal Vestibule: Novel Strategies to Prevent Side Effects

“…Available recommendations for IRT in H&N cancers underline that DNR should be below 0.35 [22]. Available dosimetric data published in a retrospective series showed that higher DNR values are not associated with an increase in terms of adverse events [16].…”

Technical details and clinical outcomes after high-dose-rate intracavitary brachytherapy for squamous cell carcinoma of external auditory canal and external beam radiotherapy for nodal coverage: A case report

“…In early-stage node negative disease, 45-54 Gy, 4-4.5 Gy per fraction in 10-12 fractions may be given (BED, 65-84 Gy) as radical treatment. Recommended dose for HDR brachytherapy boost after external irradiation is 16-22 Gy, 4-4.5 Gy per fraction in 4-5 fractions (BED, 26-32 Gy) in T1 disease, while in T2 disease, the recommended dose is 22-26 Gy, 4-4.5 Gy per fraction in 5-6 fractions (BED, 32-40 Gy) [ 12 ].…”

Acute parotitis in high-dose-rate brachytherapy treatment for skin cancer: a case report

“…Dose distribution is presented in Figure 3 . To our knowledge, there are no recommended parotid constraints in the published guidelines for skin BT treatments [ 1 - 3 ], nor specific head and neck BT recommendations [ 23 , 24 ]. In our patient, 8% of the volume of the left parotid gland was included in the CTV ( Figure 3 ), receiving a median dose of 1.31 Gy by each fraction and a total of 13.1 Gy.…”