Ahmed Akl, Presenter: Nothing to Disclose

To evaluate the outcome of patients with the diagnosis of invasive carcinoma of the oral tongue treated with External Beam Radiation and High Dose Rate (HDR) Brachytherapy as a boost.

Charts from Genesys Hurley Cancer Institute of patients with the diagnosis of invasive carcinoma of the oral tongue treated with High Dose Rate (HDR) Brachytherapy between March 2002 and December 2005 were reviewed (9 patients with squamous cell carcinoma and 1 patient with adenoid cystic carcinoma). There was 1 patient with T1N0M0 and 9 patients with T2N0M0. The patient with T1 was treated with High Dose Rate (HDR) Brachytherapy as monotherapy (8 treatments each delivered 50 Gy to the tumor plus at least 2.5 cm margin). Patients with T2N0M0 received External Beam Radiation to the neck nodes to a total dose of 46 Gy in 23 treatments, or 50.4 Gy in 28 treatments were delivered to the primary and neck nodes. High dose rate catheters were inserted two weeks post external beam. Between 8 and 12 catheters were used depending on the size of the tumor. CT treatment planning and computer-aided dosimetry to ensure adequate coverage of the target volume which would include the tumor volume prior to external beam radiation and at least 2.5 cm margin. Four tongue depressors were used to push the tongue away from the mandible prior to CT treatment planning and before each treatment. Patients received High Dose Rate treatment twice per day > 6 hours. Treatment delivered 4 Gy per fraction twice per day for 4-6 fractions depending on the tumor size and the response. The patient with adenoid cystic carcinoma received 4 Gy per fraction for 4 treatments to a large volume plus 2 fractions to a smaller volume.

All patients had complete response. The median follow up was 32.7 months (ranging from 8-84 months). Patients with T1 lesions had no evidence of disease at 50 months. One patient with T2, a 19-year-old male, relapsed locally at 12 months post radiation and salvaged with surgery. The patient relapsed again locally and expired six months post surgery. Two patients expired with no evidence of disease at 8 and 14 months post radiation treatment. Remaining patients are alive with no evidence of disease at 24, 24, 25, 26, 50, 60 and 84 months. Acute reactions manifested in all patients in the form of pain in the tongue, dryness of mouth for about three months. Two patients had persistent pain at 1 and 1 1/2 years post treatment. All patients regained their taste completely within 4-6 months post treatment. One patient developed infection post implant and was placed on antibiotics for approximately 1 month. All patients tongue function is completely normal with no limitation of movement.

HDR Brachytherapy is an effective primary therapy for T1N0M0 and as a boost for T2N0M0 invasive carcinoma of the tongue.

Akl, A, High Dose Rate "HDR" Brachytherapy as a Definitive Boost for Early Invasive Carcinoma of the Oral Tongue.  Radiological Society of North America 2008 Scientific Assembly and Annual Meeting, February 18 - February 20, 2008 ,Chicago IL. http://archive.rsna.org/2008/7001848.html