Clinical outcomes after interstitial brachytherapy for early-stage nasal squamous cell carcinoma

Abstract

Purpose: Radiotherapy of nasal carcinomas results in cure rates comparable to surgery, with anatomic preservation and good cosmesis. Brachytherapy (BT) overcomes difficulties with dosimetric coverage and affords a localized and highly conformal irradiation. We report our experience of BT for early-stage nasal squamous cell carcinomas (SCCs).

Methods and materials: Clinical data, BT parameters, and outcome of consecutive patients treated by interstitial BT in our institute between December 1982 and April 2015 for a localized nasal SCC were examined. A total of 34 patients with newly diagnosed T1-2N0-1 nasal skin (n = 22) or nasal cavity (n = 12) SCC were identified. Implantation and dosimetry were done according to the Paris system rules. Low-dose-rate (n = 30) or pulsed-dose-rate (n = 4) techniques were used. Median dose was 70 Gy (64-75 Gy). Sites of tumor recurrence, toxicity rates, and cosmesis outcome were examined.

Results: Median followup time was 89 months. All patients achieved complete response. Five patients experienced local failure, with a median interval of 9 months (range, 5-12 months). Grade 3 acute reactions were reported in 2 patients (6%). Most delayed complications were mild to moderate, and good or fair cosmesis was achieved in 97%. Estimated local failure-free survival and disease-free survival rates at 5 year were 85% (95% CI = 68-94%) and 76% (95% CI = 58-88%), respectively.

Conclusions: Interstitial BT is effective for selected nasal SCCs, with durable local control, acceptable toxicity, and good cosmesis.

Keywords: Brachytherapy; Interstitial; Nose; Squamous cell cancer.