Brachytherapy in Head and Neck Cancer: A Forgotten Art or a Skill to be Remembered!!

• A.S. Kirthi Koushik

  Department of Radiotherapy, M.S. Ramaiah Medical College, Bengaluru, India

• R.C. Alva

  Department of Radiotherapy, M.S. Ramaiah Medical College, Bengaluru, India

 Radiation therapy is a critical part of multi-modality management of head and neck cancers. Brachytherapy or internal radiation is an ideal method of treatment delivery to achieve the ultimate goal of radiation treatment, that is maximum dose to tumour and minimum dose to normal tissues. Brachytherapy enables the radiation oncologist to provide a perfect mixture of radiation physics, radiobiology and clinical acumen to counter head and neck cancers. Appropriate usage based on the clearly defined indications and simple methods can maximize the advantages of brachytherapy thus resulting in excellent outcomes. However, the steady decline in utilization of brachytherapy over the years coupled with the technological advances of highly conformal radiotherapy, have dented its broader application for head and neck cancers. Can the new age radiation oncologist afford to neglect this therapeutic skill set?

Takiar R, Nadayil D, Nandakumar A. Projections of Number of Cancer Cases in India (2010-2020) by Cancer Groups. Asian Pacific J Cancer Prev 2010; 11: 1045-1049.

Kowalski LP, Carvalho AL. Natural history of untreated head and neck cancer. Eur J Cancer 2000; 36(8): 1032-1037. https://doi.org/10.1016/S0959-8049(00)00054-X

Kovács G. Modern head and neck brachytherapy: from radium towards intensity modulated interventional brachy-therapy. J Contemp Brachytherapy 2015; 6(4): 404-416.

American College of Radiology. ACR–AAPM technical standard for the performance of high dose-rate brachytherapy physics. Available at www.acr.org/~/media/ EF9F4CCED3C5426B915BC2C91974CE5. 2015.

Mazeron JJ, Scalliet P, Van Limbergen E, Lartigau E. Radiobiology of brachytherapy and the dose-rate effect. A. Gerbaulet, R. Pötter, J.J. Mazeron, H. Meertens, E. Van Limbergen, editors. In: The GEC-ESTRO handbook of brachytherapy. ESTRO, Brussels 2002; 95-121.

Mazeron JJ, Ardiet JM, Haie-Méder C, Kovács G, Levendag P, Peiffert D, et al. GEC-ESTRO recommendations for brachytherapy for head and neck squamous cell carcinomas. Radiother Oncol 2009; 91(2): 150-6. https://doi.org/10.1016/j.radonc.2009.01.005

Inoue T, Inoue T, Yoshida K, Yoshioka Y, Shimamoto S, Tanaka E, et al. Phase III trial of high- vs. low-dose-rate interstitial radiotherapy for early mobile tongue cancer. Int J Radiat Oncol Biol Phys 2001; 51: 171-5. https://doi.org/10.1016/S0360-3016(01)01561-9

Leung T, Wong VY, Kwan K, Ng T, Wong C, Tung SY, et al. High dose rate brachytherapy for early stage oral tongue cancer. Head Neck 2002; 24(3): 274-81. https://doi.org/10.1002/hed.10021

Guinot J, Arribas L, Chust ML, Mengual JL, García Miragall E, Carrascosa M, et al. Lip cancer treatment with high dose rate brachytherapy. Radiother Oncol 2003; 69: 113-5. https://doi.org/10.1016/S0167-8140(03)00271-8

Yamazaki H, Inoue T, Yoshida K, Yoshioka Y, Furukawa S, Kakimoto N, et al. Brachytherapy for early oral tongue cancer: low dose rate to high dose rate. J Radiat Res 2003; 44: 37-40. https://doi.org/10.1269/jrr.44.37

Umeda M, Komatsubara H, Ojima Y, Minamikawa T, Shibuya Y, Yokoo S, et al. A comparison of brachytherapy and surgery for the treatment of stage I-II squamous cell carcinoma of the tongue. Int J Oral Maxillofac Surg 2005; 34: 739-44. https://doi.org/10.1016/j.ijom.2005.02.015

Kakimoto N, Inoue T, Inoue T, Murakami S, Furukawa S, Yoshida K, et al. High-dose-rate interstitial brachytherapy for mobile tongue cancer: influence of the non-irradiated period. Anticancer Res 2006; 26: 3933-7.

Ghadjar P, Bojaxhiu B, Simcock M, Terribilini D, Isaak B, Gut P, et al. High dose rate versus low dose-rate brachytherapy for lip cancer. Int J Radiat Oncol Biol Phys 2012; 83(4): 1205-12. https://doi.org/10.1016/j.ijrobp.2011.09.038

Mohanti BK, Sahai P, Thakar A, Sikka K, Bhasker S, Sharma A, et al. Institutional Experience of Interstitial Brachytherapy for Head and Neck Cancer with a Comparison of High- and Low Dose Rate Practice. Asian Pac J Cancer Prev 2014; 15(2): 813-818. https://doi.org/10.7314/APJCP.2014.15.2.813

Kakimoto N, Inoue T, Inoue T, Murakami S, Furukawa S, Yoshida K, et al. Results of low- and high-dose-rate interstitial brachytherapy for T3 mobile tongue cancer. Radiother Oncol 2003; 68: 123-8. https://doi.org/10.1016/S0167-8140(03)00055-0

Nose T, Koizumi M, Nishiyama K. High-dose-rate interstitial brachytherapy for oropharyngeal carcinoma: results of 83 lesions in 82 patients. Int J Radiat Oncol Biol Phys 2004; 59: 983-91. https://doi.org/10.1016/j.ijrobp.2003.12.015

Takácsi-Nagy Z, Polgár C, Oberna F, Somogyi A, Major T, Remenár É, et al. Interstitial high-dose-rate brachytherapy in the treatment of base of tongue carcinoma. Strahlenther Onkol 2004; 180(12): 768-75. https://doi.org/10.1007/s00066-004-1238-x

Chen J, Pappas L, Moeller JH, Rankin J, Sharma PK, Bentz BG, et al. Treatment of oropharyngeal squamous cell carcinoma with external beam radiation combined with interstitial brachytherapy. Head Neck 2007; 29(4): 362-9. https://doi.org/10.1002/hed.20528

Yamazaki H, Yoshida K, Yoshioka Y, Shimizutani K, Furukawa S, Koizumi M, et al. High dose rate brachytherapy for oral cancer. J Radiat Res 2013; 54(1): 1-17. https://doi.org/10.1093/jrr/rrs103

Krüll A, Friedrich RE, Schwarz R, Thurmann H, Schmelzle R, Alberti W. Interstitial high dose rate brachytherapy in locally progressive or recurrent head and neck cancer. Anticancer Res 1999; 19(4A): 2695-7.

Glatzel M, Buntzel J, Schroder D, Küttner K, Frohlich D. High-dose-rate brachytherapy in the treatment of recurrent and residual head and neck cancer. Laryngoscope 2002;112; 8(1): 1366-71.

Narayana A, Cohen GN, Zaider M, Chan K, Lee N, Wong RJ, et al. High-dose-rate interstitial brachytherapy in recurrent and previously irradiated head and neck cancers – preliminary results. Brachytherapy 2007; 6(2): 157-63. https://doi.org/10.1016/j.brachy.2006.12.001

Schiefke F, Hildebrandt G, Pohlmann S, Heinicke F, Hemprich A, Frerich B. Combination of surgical resection and HDR-brachytherapy in patient with recurrent or advanced head and neck carcinomas. J Craniomaxillofac Surg 2008; 36(5): 285-92. https://doi.org/10.1016/j.jcms.2007.08.009

Bartochowska A, Wierzbicka M, Skowronek J, Leszczyńska M, Szyfter W. High-dose-rate and pulsed-dose-rate brachytherapy in palliative treatment of head and neck cancers. Brachytherapy 2012; 11(2): 137-43. https://doi.org/10.1016/j.brachy.2011.09.006

Orton A, Boothe D, Gan M, Monroe MM, Hitchcock YJ, Lloyd S. The "decay" of brachytherapy use in tumors of the oral cavity: A population-based patterns of care and outcomes analysis from 1973 to 2012. Brachytherapy 2016; 15(6): 851-858. https://doi.org/10.1016/j.brachy.2016.05.007

• PDF