The role of brachytherapy for margin control in oral tongue squamous cell carcinoma
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(2020) 49:74
ORIGINAL RESEARCH ARTICLE
Open Access
The role of brachytherapy for margin control in oral tongue squamous cell carcinoma Ilia Ianovski1, Alex M. Mlynarek2, Martin J. Black2, Boris Bahoric3, Khalil Sultanem3 and Michael P. Hier2*
Abstract Background: The aim of this study is to assess the feasibility and effectiveness of using peri-operative brachytherapy (BRTx) for positive/narrow margins present post primary surgical resection of oral tongue squamous cell carcinoma (OTSCC). Methods: Prospective single-centre study of patients with OTSCC (T1–3, N0–3, M0) treated with resection of primary tumour ± regional nodal resection and intra-operative insertion of BRTx catheters. BRTx was administered twice daily at 40.8Gy/12Fr for ‘Positive’ (≤2 mm) margins, at 34Gy/10Fr for ‘Narrow’ (2.1-5 mm) margins, and not given for ‘Clear’ (> 5 mm) margins over the course of 5–6 days, 3–5 days post operatively. Results: Out of 55 patients recruited 41 patients (74.6%) were treated with BRTx, as 12 patients had clear margins and 2 patients had unfavourable tumour anatomy for catheter insertion. EBRTx was avoided in 64.3% of patients. Overall Survival (OS) at 3 and 5 years was 75.6 and 59.1% respectively, while Disease Specific Survival (DSS) was 82.3 and 68.6% at 3 and 5 years respectively. Recurrence and survival outcomes were not associated with margin status or the use of or specific dose of BRTx on Cox regression analysis. Acute and late toxicity secondary to BRTx was minimal. Conclusions: The use of BRTx after primary OTSCC resection with positive/narrow margins ± EBRTx to the neck ± CTx achieves outcomes comparable to traditional treatment of surgery followed by re-resection or EBRTx ± CTx. Morbidity associated with oral cavity EBRTx or secondary resection and reconstruction is thus avoided. Both acute and late toxicity rates are low and compare favourably with other BRTx OTSCC studies. Trial registration: Retrospectively registered. https://www.mcgill.ca/rcr-rcn/files/rcr-rcn/2017.06.05_rcn_hn.pdf. Level of evidence: 4 Keywords: Oral cavity, Radiation therapy, Neck dissection, Squamous cell carcinoma, Tongue cancer, Oral cancer, Brachytherapy, Survival
* Correspondence: [email protected] Presented as a poster at Combined Otolaryngology Spring Meeting, American Head & Neck Society Meeting, National Harbor, April 18-19, 2018. 2 Department of Otolaryngology – Head & Neck Surgery, Jewish General Hospital, McGill University, Montreal, Quebec, Canada Full list of author information is available at the end of the article © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless in
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