INTERSTITIAL AND SURFACE MOLD BRACHYTHERAPY FOR HEAD AND NECK CANCERS- AN INSTITUTIONAL EXPERIENCE
PD-0418
Abstract
INTERSTITIAL AND SURFACE MOLD BRACHYTHERAPY FOR HEAD AND NECK CANCERS- AN INSTITUTIONAL EXPERIENCE
Authors: BHARTI DEVNANI1, Puneet Pareek1, Josmi Joseph1, Amith Mohan1, Irfad MP1, Muhsin Punchankandy1, Rakesh Kumar Vyas1, Akanksha Solanki1, Ankita Chugh2, Dharma Ram Poonia3, Jeewan Ram Vishnoi3, Priyanka Sethi4, Sanjeev Misra3
1All India Institute of Medical Sciences, Department of Radiation Oncology, Jodhpur, India; 2All India Institute of Medical Sciences, Department of Dentistry, Jodhpur, India; 3All India Institute of Medical Sciences, Department of Surgical Oncology, Jodhpur, India; 4All India Institute of Medical Sciences, Departemnt of Anesthesia, Jodhpur, India
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Purpose or Objective
Brachytherapy is an important treatment modality for squamous cell carcinoma (SCC) of head and neck cancers. The aim of this study is to report the outcome of patients treated with interstitial brachytherapy (ISBT) and surface mold HDR- brachytherapy (HDR-BT) for Head and Neck carcinomas in the Department of Radiation Oncology at All India Institute of Medical Sciences, Jodhpur, India.
Material and Methods
Total five patients of head and neck cancers were treated with HDR -BT between 2020-22. There were two patients treated with brachytherapy alone as a
radical setting and as a salvage re-radiation post primary treatment in other three cases. The catheters were placed using the free hand technique. CT based planning was done for all the patients and a customized wax coated lead shield was placed to protect the alveolar structures. Surface mold brachytherapy was employed in isolated small superficial (<5mm deep) palatal recurrence post radiation and not willing for surgery using an acrylic mould along with flexible nylon catheters. The dose fractionation used was 4.0 Gy twice per day (b.i.d) to 44 Gy for definitive treatment and 3Gy b.i.d to 36 Gy in recurrent setting. HDR -BT was started 5 days after catheter insertion to allow adequate healing of the tissue and settling of edema. Patients were followed up as per the institute protocol.
Results
The median follow-up of the patients was 10 months. The mean dose in radical and reirradiation settings was 44Gy in 11 fractions and 36 Gy in 12 fractions respectively.The acute toxicity outcome was measured by RTOG toxicity grading and majority of the acute toxicities were Grade II . Barring one patient, rest of the patients had complete response at local site on last follow-up. The procedures were uneventful and no significant post-operative complications were noted.
Conclusion
Interstitial brachytherapy for early head and neck cancer is a viable option and should be utilized wherever indicated. Mold brachytherapy provides an excellent salvage radiation therapy alternative to surgery and helps preserve the organ function with similar survival outcomes and good toxicity outcomes.