The role of brachytherapy for margin control in oral tongue squamous cell carcinoma

Journal of Otolaryngology - Head & Neck Surgery

Boris Bahoric¹  Khalil Sultanem¹  Ilia Ianovski²  Michael P. Hier³  Martin J. Black³  Alex M. Mlynarek³ 

[1] Department Radiation Oncology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada;Department of Otolaryngology – Head & Neck Surgery, Auckland District Health Board, Auckland City Hospital, Auckland, New Zealand;Department of Otolaryngology – Head & Neck Surgery, Jewish General Hospital, McGill University, Montreal, Quebec, Canada;

关键词: Oral cavity;    Radiation therapy;    Neck dissection;    Squamous cell carcinoma;    Tongue cancer;    Oral cancer;    Brachytherapy;    Survival;   

DOI  :  10.1186/s40463-020-00467-w

来源: Springer

【 摘 要 】

BackgroundThe aim of this study is to assess the feasibility and effectiveness of using peri-operative brachytherapy (BRTx) for positive/narrow margins present post primary surgical resection of oral tongue squamous cell carcinoma (OTSCC).MethodsProspective single-centre study of patients with OTSCC (T1–3, N0–3, M0) treated with resection of primary tumour ± regional nodal resection and intra-operative insertion of BRTx catheters. BRTx was administered twice daily at 40.8Gy/12Fr for ‘Positive’ (≤2 mm) margins, at 34Gy/10Fr for ‘Narrow’ (2.1-5 mm) margins, and not given for ‘Clear’ (> 5 mm) margins over the course of 5–6 days, 3–5 days post operatively.ResultsOut of 55 patients recruited 41 patients (74.6%) were treated with BRTx, as 12 patients had clear margins and 2 patients had unfavourable tumour anatomy for catheter insertion. EBRTx was avoided in 64.3% of patients. Overall Survival (OS) at 3 and 5 years was 75.6 and 59.1% respectively, while Disease Specific Survival (DSS) was 82.3 and 68.6% at 3 and 5 years respectively. Recurrence and survival outcomes were not associated with margin status or the use of or specific dose of BRTx on Cox regression analysis. Acute and late toxicity secondary to BRTx was minimal.ConclusionsThe use of BRTx after primary OTSCC resection with positive/narrow margins ± EBRTx to the neck ± CTx achieves outcomes comparable to traditional treatment of surgery followed by re-resection or EBRTx ± CTx. Morbidity associated with oral cavity EBRTx or secondary resection and reconstruction is thus avoided. Both acute and late toxicity rates are low and compare favourably with other BRTx OTSCC studies.Trial registrationRetrospectively registered. https://www.mcgill.ca/rcr-rcn/files/rcr-rcn/2017.06.05_rcn_hn.pdf.Level of evidence4Graphical abstract

【 授权许可】

CC BY