Treatment of oropharyngeal squamous cell carcinoma with external beam radiation combined with interstitial brachytherapy

Chen, Jergin; Pappas, Lisa M.; Moeller, John F.; Rankin, James A.; Sharma, Pramod Kumar; Bentz, Brandon G.; Fang, Liwei; Hayes, John K.; Shrieve, Dennis C.; Hitchcock, Ying J.

doi:10.1002/hed.20528

Cited by 10 publications

(13 citation statements)

References 34 publications

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“…In terms of RT technique, our preferred choice for decades had been combination EBRT with interstitial brachytherapy boost . In our experience using EBRT + IB for treatment of stage III/IV patients, the 5‐year LC, DFS, and OS rates were 79%, 62%, and 49%, respectively.…”

Section: Discussionmentioning

confidence: 91%

“…The median total dose of EBRT + IB to the primary tumor was 75 Gy (range, 50–89 Gy), with a median EBRT dose of 50 Gy (range, 30–66 Gy) and a median IB dose of 25 Gy (range, 20–35 Gy). The technique of IB was previously described and planned neck dissection was performed at the time of catheter implant. IB was delivered via either low dose rate (LDR) or high dose rate (HDR).…”

Section: Methodsmentioning

confidence: 99%

“…These include dose escalation using interstitial brachytherapy (IB) with conformal EBRT, accelerated or altered fractionation, and radiosensitization with the addition of chemotherapy. IB had been used to boost high RT doses to the tumor while sparing normal tissues, and had been used for decades in combination with EBRT for the treatment of advanced BOT SCC, with reported locoregional control (LRC) rates of 70–90% . Accelerated or altered fractionation has been shown to improve LRC .…”

Section: Introductionmentioning

confidence: 99%

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Clinical outcomes associated with evolving treatment modalities and radiation techniques for base‐of‐tongue carcinoma: thirty years of institutional experience

et al. 2015

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Curative treatment for base-of-tongue squamous cell carcinoma (BOT SCC) has evolved over time; however, comparative outcomes analysis for various treatment strategies is lacking. The authors reviewed the evolution of treatment modality and radiotherapy (RT) technique for 231 consecutive BOT SCC patients at our institution between 1981 and 2011. Treatment modalities included definitive chemoradiotherapy (chemoRT) (42%), definitive RT (33%), surgery followed by RT (20%), and surgery alone (5%). RT techniques included external beam plus interstitial brachytherapy (EBRT + IB) (37%), conventional EBRT (29%), intensity-modulated radiation therapy ± simultaneous integrated boost (IMRT ± SIB) (34%). Clinical characteristics and outcomes were stratified by modality or RT technique. Treatment modality evolved from definitive RT (1980s–1990s) to definitive chemoRT (1990s–2000s). RT technique evolved from EBRT + IB (1980s–1990s) to conventional EBRT (1990s–2000s) to IMRT + SIB (2000s). With median alive follow-up of 6 years (0.3–28 years), the 5-year LC, LRC, and OS rates were 80%, 73%, and 51%. There was no difference in distribution of gender, age, stage among treatment modalities. Definitive chemoRT had improved LRC (HR 1.6) and OS (HR 1.7) compared to definitive RT. IMRT + SIB had improved LRC (HR 3.2), DFS (HR 3.4), and OS (HR 3.0) compared to conventional EBRT. Over the past 30 years, BOT SCC treatment has undergone major paradigm shifts that incorporate nonsurgical functional preservation, concurrent chemotherapy, and advanced RT techniques. Excellent locoregional control and survival outcomes are associated with accelerated IMRT with chemotherapy.

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Section: Discussionmentioning

confidence: 91%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Clinical outcomes associated with evolving treatment modalities and radiation techniques for base‐of‐tongue carcinoma: thirty years of institutional experience

et al. 2015

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“…In contrast to late mucosal ulcers, the incidence of late severe dysphagia (16.5%) seems higher in the current study compared to previously published data. In the study by Chen et al, 6% of patients treated with brachytherapy in combination with external beam radiotherapy and/or surgery experienced severe dysphagia [ 17 ]. After external beam radiotherapy to standard curative dose, severe dysphagia is seen in 5–9% [ 39 , 40 ].…”

Section: Discussionmentioning

confidence: 99%

Dose escalation in oropharyngeal cancer: a comparison of simultaneous integrated boost and brachytherapy boost

et al. 2023

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Background Local recurrence is the most common pattern of failure in head and neck cancer. It can therefore be hypothesised that some of these patients would benefit from an intensified local treatment, such as radiation dose escalation of the primary tumour. This study compares treatment and toxicity outcomes from two different boost modalities in oropharyngeal cancer: simultaneous integrated boost (SIB) and brachytherapy boost. Methods Two hundred and forty-four consecutive patients treated with > 72 Gy for oropharyngeal squamous cell carcinoma between 2011 and 2018 at our institution were retrospectively analysed. Data on side effects were collected from a local quality registry and supplemented with a review of medical records. Patients receiving a brachytherapy boost first had external beam radiotherapy consisting of 68 Gy in 2 Gy fractions to the gross tumour volume (GTV), and elective radiotherapy to the neck bilaterally. The brachytherapy boost was typically given using pulsed dose rate, 15 fractions and 0.56–0.66 Gy per fraction [total dose in EQD2 = 75.4–76.8 Gy (α/β = 10)]. The typical dose escalated radiotherapy with external beam radiotherapy only, was delivered using SIB with 74,8 Gy in 2.2 Gy fractions [EQD2 = 76.0 Gy (α/β = 10)] to the primary tumour, 68 Gy in 2 Gy fractions to GTV + 10 mm margin and elective radiotherapy to the neck bilaterally. Results Dose escalation by SIB was given to 111 patients and brachytherapy boost to 134 patients. The most common type of cancer was base of tongue (55%), followed by tonsillar cancer (42%). The majority of patients had T3- or T4-tumours and 84% were HPV-positive. The 5-year OS was 72,4% (95% CI 66.9–78.3) and the median follow-up was 6.1 years. Comparing the two different dose escalation modalities we found no significant differences in OS or PFS and these results remained after a propensity-score matched analysis was performed. The analysis of grade ≥ 3 side effects showed no significant differences between the two different dose escalation techniques. Conclusions We found no significant differences in survival or grade ≥ 3 side effects comparing simultaneous integrated boost and brachytherapy boost as alternative dose escalation modalities in the treatment of oropharyngeal cancer.

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“…Our management of neck metastases differs significantly from the approach taken at other institutions. Many surgeons advocate elective neck dissection for patients with N2 to N3 metastasis either prior to or after chemoradiation treatment 16, 18, 19. At our institution, we treated the neck with brachytherapy if the neck was N+ at initial presentation.…”

Section: Discussionmentioning

confidence: 99%

Management of squamous cell carcinoma of the base of tongue with chemoradiation and brachytherapy

Cano

Lai²,

Çaylaklı³

et al. 2009

Head & Neck

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Treatment of oropharyngeal squamous cell carcinoma with external beam radiation combined with interstitial brachytherapy

Abstract: EBRT combined with interstitial brachytherapy provide good local control rates for locally advanced oropharyngeal squamous cell carcinoma.

Cited by 10 publications

References 34 publications

Clinical outcomes associated with evolving treatment modalities and radiation techniques for base‐of‐tongue carcinoma: thirty years of institutional experience

Clinical outcomes associated with evolving treatment modalities and radiation techniques for base‐of‐tongue carcinoma: thirty years of institutional experience

Dose escalation in oropharyngeal cancer: a comparison of simultaneous integrated boost and brachytherapy boost

Management of squamous cell carcinoma of the base of tongue with chemoradiation and brachytherapy

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