Results of radiation therapy in carcinoma of the base of the tongue. The curie institute experience with about 166 cases

Abstract

Between 1960 and 1980, 166 patients with squamous cell carcinoma of the base of the tongue were treated with primary irradiation at the Curie Institute (Paris, France). Distribution according to the TNM system 1978 International Union Against Cancer (UICC) was the following: 22 T1 lesions, 47 T2 lesions, 64 T3 lesions, and 33 T4 lesions. Regional nodes were not palpable in 50 cases, 35 had N1 nodes, 12 had N2 nodes, and 69 had N3 nodes. All patients received external beam radiation. The 2-year, 3-year, and 5-year overall survival rates for all patients were, respectively, 45%, 37%, and 27%. Local control was significantly related to the initial status of the primary, to the tumor regression at the end of the radiation therapy, and to the histologic differentiation. The 2-year local control was 96% for T1 lesions, 57% for T2 lesions, 45% for T3 lesions, and 23% for T4 lesions. Local control was 70% if the tumor regression was complete at the end of the treatment and 27% if the tumor regression was partial. No significant differences were found in primary local control with respect to degree of infiltration, age, and dose of radiation therapy over a dose of 60 Gy in 6 weeks. The 3-year regional control was 86% for N0, 78% for N1, and 60% for N2 and N3. Among the tumor characteristics analyzed, the most useful ones for predicting local control and survival were clinical tumor staging parameters and tumor radiation-induced regression. A new therapeutic approach based on the evaluation of the tumor regression at 50/55 Gy is under discussion.

High-dose-rate interstitial brachytherapy for oropharyngeal carcinoma: results of 83 lesions in 82 patients

“…For group C, compared to the excellent LC for early cases (90%), LC for advanced cases has proven less than satisfactory (Kaplan-Meier, 26%). Compared to results in the literature (Kaplan-Meier or actuarial, 37-82% for T3, 15-38% for T4), our results seem slightly worse or equivalent (3,4,18,19). To control these large or infiltrating tumors, higher HDRIB dose or concurrent chemotherapy might be necessary.…”

“…By joining early and advanced subsets, the influence of stage migration could be eliminated. For the entire group C, LC was 69%, equivalent to previous radiotherapy results in the literature (Kaplan-Meier or actuarial, 44 -89%), although the current series included 16% apparent T4a patients (3,4,18,19). In groups A and C, 6 patients with superficial lesions underwent mono- Abbreviations: RT ϭ external radiotherapy; pND ϭ planned neck dissection; LDR ϭ low-dose-rate interstitial brachytherapy; HDR ϭ high-dose-rate interstitial brachytherapy; KM ϭ Kaplan-Meier; A ϭ soft palate, tonsil, posterior pillar; B ϭ anterior pillar, glossotonsillar sulcus; C ϭ base of tongue, vallecula; SP ϭ soft palate; AP ϭ anterior pillar; GTS ϭ glossotonsillar sulcus.…”

Brachytherapy in the treatment of Stage IV carcinoma of the base of tongue

“…Our results appear to be satisfactory not only in terms of high local control rates (89%) but also because of an improved overall and DSS (13,18,(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31). Our surviving patients have managed to live with no major disabilities except for some xerostomia, and most patients have enjoyed the eventual return of their taste (32)(33)(34)(35)(36)(37).…”

Interstitial High-Dose-Rate Brachytherapy in the Treatment of Base of Tongue Carcinoma

“…Brunin et al [3] used teletherapy alone to treat patients with locally advanced disease, and the local control rate was 45% for T3 and 18% for T4 cases. In the Jaulerry et al [23] study with sole radiotherapy the 2-year local control rate was 45% for T3, and 23% for T4 lesions with a 5-year overall survival of 27% for all cases. On the base of published results improved local control could be achieved with the combination of teletherapy and brachytherapy (see Table 4).…”