Is There Still a Place for Brachytherapy in the Modern Treatment of Early-Stage Oral Cancer?

Abstract

Brachytherapy (BT) involves the direct application of radioactive sources to the tumour. This technique is characterised by a steep dose gradient, the delivery of high-dose radiation to the target volume centre, and the sparing of surrounding healthy tissues. Low-dose-rate (LDR) BT and manual afterloading played an important role in the treatment of early-stage oral cancer, with treatment outcomes that were comparable to surgery. Interest in BT as a primary treatment for oral cancer has declined in recent years due to the emergence of better surgical techniques, the switch from LDR BT to high-dose-rate (HDR) BT (which has a higher risk of complications), and to advances in external beam radiotherapy (EBRT). At present, the main indications for BT are in the postoperative setting due to the superior dose conformity and better quality of life offered by BT versus EBRT. Postoperative BT can be administered as monotherapy in early-stage (T1N0) cancers and in combination with elective neck dissection or EBRT to treat larger or deeper tumours. BT yields excellent results for lip carcinoma in older patients and in tumours with unfavourable localisations. BT is an effective salvage therapy for local recurrences in previously-irradiated areas. Despite its many advantages, brachytherapy is a complex treatment requiring meticulous technique and close cooperation between the radiation oncologist, physicist, and surgeon.

Advances in Head-and-Neck Interventional Radiotherapy (Brachytherapy)

“…Typical examples of catheter implants performed according to the Paris system include tongue [2] and lip cancer. [3]More recently a different concept has been proposed in the context of nasal vestibules, that is the anatomical implant.…”

Chemoradiotherapy for Head and Neck Cancer

“…The essential requirements for brachytherapy are skills in the technique and the expertise of the radiation oncologist, as well as a close partnership between the surgeons and physicist. Tucek et al [4] reviewed the role of brachytherapy in the treatment of early-stage oral cavity cancer in the modern era. The review provided an overview of the principles and historical background of brachytherapy.…”