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. 2021 Mar 19;13(6):1387.
doi: 10.3390/cancers13061387.

Pulsed Dose Rate Brachytherapy of Lip Carcinoma: Clinical Outcome and Quality of Life Analysis

Radouane El Ayachy  1 , Roger Sun  1 , Kanta Ka  1 , Adrien Laville  1 , Anne-Sophie Duhamel  1 , Anne Tailleur  1 , Isabelle Dumas  1 , Sophie Bockel  1 , Sophie Espenel  1 , Pierre Blanchard  1 , Yungan Tao  1 , Stéphane Temam  2 , Antoine Moya-Plana  2 , Christine Haie-Meder  1   3 , Cyrus Chargari  1   4
Affiliations

Pulsed Dose Rate Brachytherapy of Lip Carcinoma: Clinical Outcome and Quality of Life Analysis

Radouane El Ayachy et al. Cancers (Basel). .

Abstract

Purpose: Lip carcinoma represents one of the most common types of head and neck cancer. Brachytherapy is a highly effective therapeutic option for all stages of lip cancers. We report our experience of pulsed dose rate brachytherapy (PDR) as treatment of lip carcinoma.

Methods and materials: this retrospective single center study included all consecutive patients treated for a lip PDR brachytherapy in our institution from 2010 to 2019. The toxicities and outcomes of the patients were reported, and a retrospective quality of life assessment was conducted by phone interviews (FACT H&N).

Results: From October 2010 to December 2019, 38 patients were treated in our institution for a lip carcinoma by PDR brachytherapy. The median age was 73, and the majority of patients presented T1-T2 tumors (79%). The median total dose was 70.14 Gy (range: 60-85 Gy). With a mean follow-up of 35.4 months, two patients (5.6%) presented local failure, and seven patients (19%) had lymph node progression. The Kaplan-Meier estimated probability of local failure was 7.2% (95% CI: 0.84-1) at two and four years. All patients encountered radiomucitis grade II or higher. The rate of late toxicities was low: three patients (8.3%) had grade II fibrosis, and one patient had grade II chronic pain. All patients would highly recommend the treatment. The median FACT H&N total score was 127 out of 148, and the median FACT H&N Trial Outcome Index was 84.

Conclusions: This study confirms that an excellent local control rate is achieved with PDR brachytherapy as treatment of lip carcinoma, with very limited late side effects and satisfactory functional outcomes. A multimodal approach should help to improve regional control.

Keywords: brachytherapy; lip cancer; pulsed dose rate; quality of life; radiation therapy; radiotherapy.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Example of brachytherapy implantation for a T1 N0 squamous cell carcinoma of the inferior lip. Tumor was measured at 18 × 15 mm² and localized in the mid lip (A). Implantation was performed following Paris system rules with two planes. Four needles were used, including one needle in plesiotherapy to increase the dose at the level of the tumor (B). The patient experienced acute reaction with radiomucitis grade II at week 6. At week 23, complete response was achieved with disappearance of all acute reactions and without any sequalae (C).
Figure 2
Figure 2
Example of brachytherapy implantation for a T3 N0 squamous cell carcinoma of the inferior lip. Tumor was measured at 60 mm and localized in the inferior lip (A). Implantation was done following Paris system rules with two planes arranged in squares with 15 mm spacing. Four needles were used (B). The dose distribution was optimal, with high dose to the tumor (>70 Gy) while minimizing dose to the bone (C). Patient experienced acute reaction with radiomucitis grade II at week 8 (D). At one year, complete response was achieved with disappearance of all acute reactions and persistence of a small fibrotic scare (E).
Figure 3
Figure 3
Incidence of local failures, progression-free survival and overall survival curves.
Figure 3
Figure 3
Incidence of local failures, progression-free survival and overall survival curves.
See this image and copyright information in PMC

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