11 Lip and buccal mucosa

Lip and buccal mucosa

11

THE GEC ESTROHANDBOOKOF BRACHYTHERAPY | Part II Clinical Practice Version 1 - 10/05/2019

Fig 17: SCC. HDR 5.3 Gy x 9 fractions (EQD2 60.8 Gy) plus elective neck EBRT. Eight needles. Results at 2 years.

Fig 18: Recurrence after surgery, commissure tumour involving buccal mucosa, treated with oblique rigid needles. HDR 5Gy x 9 fractions (EQD2: 56.2 Gy). Results at one year

The largest study, was published in 2013, with 104 patients treated with rigid needles, 45 Gy in 9 fractions [4]. The 7-year actuarial control was 100% in T1, 93.6% in T2 and 79% in T4. The most interesting data is that there were no cases of lip or bone necrosis, compared with 15% with LDR in the previous experience, and preserved function in 100% of cases. An update of 68 T1-2 cases achieved a control of 96.5% [41].

carcinoma (Table 3) [7-8-19-20-42-43]. In these different studies, patients were treatedwith brachytherapy alone (A) or with combined external-beam radiation and brachytherapy boost (B) in nearly 700 cases. When the two treatments are compared, survival and local-control rates are better for brachytherapy 60% versus 35% and 75% versus 60%, respectively. 12.2.2 Local control with HDR/PDR Few reports show the results of HDR or PDR in buccal mucosa carcinoma. The current practice is similar to lip carcinoma with no apparent differences regarding local control, compared with LDR, and fewer complications, due to the optimization of the dose, according to personal experience.

12.2 Results buccal mucosa 12.2.1 Local control with LDR

The largest multicentre study was done by the GEC (Groupe Européen de Curiethérapie) ESTRO [9]. Seven hundred forty-eight patients were treated for primary tumour with: brachytherapy alone (31%) (A), combination of external beam irradiation + brachytherapy (11%) (B), external beam irradiation alone (36%) (C), surgery often followed by radiation therapy (22%) (D). These different therapeutic approaches were adapted to prognostic factors: tumour size, tumour site, nodal status. (12) Five-year NED survival rate according to T stage was: T1 61%, T2 46%, T3 33%, T4 10%. For the various treatments, the local failure rate (including all primary tumours) was: 19% for brachytherapy alone, 35% for combination external beam irradiation + brachytherapy and for external beam irradiation alone, 22% for surgery ±- external beam irradiation. With the exception of the GEC ESTROmulticentre trial, few other reports have been published of brachytherapy in buccal-mucosa

13. ADVERSE SIDE EFFECTS

Since the lip is relatively radioresistent; severe complications are rare. Superficial necroses occur in 2.8 - 10.1% [27-28-30-31]. They heal spontaneously in 70% before six months or after hyperbaric oxygen therapy inmore than 95%, and require surgery in less than 5% of cases [30]. Lip ulceration depends strongly on total dose and dose rate. In the GEC-ESTRO overview 27 the incidence of lip ulceration was 0%with doses under 50 Gy, 4.8% for 50 - 60 Gy,