Long-term outcomes after external beam irradiation and brachytherapy boost for base-of-tongue cancers

Iris C. Gibbs, Quynh Thu Le, Rachit D. Shah, David J Terris, Willard E. Fee, Don R. Goffinet

Research output: Contribution to journalArticle

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Abstract

Purpose: To assess long-term efficacy and toxicity associated with external beam irradiation (EBRT) and interstitial 192Ir implantation for the treatment of squamous carcinoma of the base of tongue. Methods and Materials: Between April 1975 and December 1993, 41 patients with base-of-tongue carcinomas were treated with 192Ir interstitial implants after EBRT at Stanford University. One patient had Stage I, 6 had Stage II, 7 had Stage III, and 27 had Stage IV tumors. Twenty-eight patients had cervical lymph node involvement at diagnosis. All received EBRT to a median dose of 50 Gy (range 48.9-68 Gy) to the primary tumor and regional lymph nodes before brachytherapy. Interstitial implant was performed 2-4 weeks after EBRT. Intraoperatively, nylon catheters were placed via steel trocars into the base of tongue, glossotonsillar groove, and pharyngo-epiglottic fold using a catheter looping technique. Twenty-three of 28 node-positive patients also underwent simultaneous neck dissections. Postoperatively, the 192Ir seeds were inserted and allowed to remain in place for approximately 35 h to achieve a median tumor dose of 26 Gy (range 20-34 Gy) to a median volume of 73 cc. Survival, local control, and complications were assessed. Results: With a median follow-up of 62 months (range 9-215) for all patients and 90 months for alive patients, the 5-year Kaplan-Meier survival estimate was 66%. The 5-year local control rate was 82%, with 7 patients recurring locally, 2 of whom were salvaged with surgery. Nodal control was achieved in 93% of patients with either EBRT alone or in combination with neck dissection. The 5-year freedom from distant metastasis rate was 83%. Acute complications included transient bleeding (5%) and infection (8%). Late complication included soft-tissue necrosis/ulceration (7%), osteoradionecrosis (5%), and xerostomia. Conclusion: Base-of-tongue carcinoma can be effectively treated with EBRT and 192Ir implant boost. Local control is excellent and complication rates are acceptable.

Original languageEnglish (US)
Pages (from-to)489-494
Number of pages6
JournalInternational Journal of Radiation Oncology Biology Physics
Volume57
Issue number2
DOIs
StatePublished - Oct 1 2003
Externally publishedYes

Fingerprint

Tongue Neoplasms
tongue
Brachytherapy
acceleration (physics)
cancer
irradiation
Tongue
dissection
interstitials
Neck Dissection
tumors
lymphatic system
Catheters
Lymph Nodes
Osteoradionecrosis
Carcinoma
Xerostomia
bleeding
dosage
Neoplasms

Keywords

  • Base of tongue
  • Brachytherapy
  • Radiotherapy
  • Squamous cell carcinomas

ASJC Scopus subject areas

  • Radiation
  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Cancer Research

Cite this

Long-term outcomes after external beam irradiation and brachytherapy boost for base-of-tongue cancers. / Gibbs, Iris C.; Le, Quynh Thu; Shah, Rachit D.; Terris, David J; Fee, Willard E.; Goffinet, Don R.

In: International Journal of Radiation Oncology Biology Physics, Vol. 57, No. 2, 01.10.2003, p. 489-494.

Research output: Contribution to journalArticle

Gibbs, Iris C. ; Le, Quynh Thu ; Shah, Rachit D. ; Terris, David J ; Fee, Willard E. ; Goffinet, Don R. / Long-term outcomes after external beam irradiation and brachytherapy boost for base-of-tongue cancers. In: International Journal of Radiation Oncology Biology Physics. 2003 ; Vol. 57, No. 2. pp. 489-494.
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abstract = "Purpose: To assess long-term efficacy and toxicity associated with external beam irradiation (EBRT) and interstitial 192Ir implantation for the treatment of squamous carcinoma of the base of tongue. Methods and Materials: Between April 1975 and December 1993, 41 patients with base-of-tongue carcinomas were treated with 192Ir interstitial implants after EBRT at Stanford University. One patient had Stage I, 6 had Stage II, 7 had Stage III, and 27 had Stage IV tumors. Twenty-eight patients had cervical lymph node involvement at diagnosis. All received EBRT to a median dose of 50 Gy (range 48.9-68 Gy) to the primary tumor and regional lymph nodes before brachytherapy. Interstitial implant was performed 2-4 weeks after EBRT. Intraoperatively, nylon catheters were placed via steel trocars into the base of tongue, glossotonsillar groove, and pharyngo-epiglottic fold using a catheter looping technique. Twenty-three of 28 node-positive patients also underwent simultaneous neck dissections. Postoperatively, the 192Ir seeds were inserted and allowed to remain in place for approximately 35 h to achieve a median tumor dose of 26 Gy (range 20-34 Gy) to a median volume of 73 cc. Survival, local control, and complications were assessed. Results: With a median follow-up of 62 months (range 9-215) for all patients and 90 months for alive patients, the 5-year Kaplan-Meier survival estimate was 66{\%}. The 5-year local control rate was 82{\%}, with 7 patients recurring locally, 2 of whom were salvaged with surgery. Nodal control was achieved in 93{\%} of patients with either EBRT alone or in combination with neck dissection. The 5-year freedom from distant metastasis rate was 83{\%}. Acute complications included transient bleeding (5{\%}) and infection (8{\%}). Late complication included soft-tissue necrosis/ulceration (7{\%}), osteoradionecrosis (5{\%}), and xerostomia. Conclusion: Base-of-tongue carcinoma can be effectively treated with EBRT and 192Ir implant boost. Local control is excellent and complication rates are acceptable.",
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AU - Fee, Willard E.

AU - Goffinet, Don R.

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N2 - Purpose: To assess long-term efficacy and toxicity associated with external beam irradiation (EBRT) and interstitial 192Ir implantation for the treatment of squamous carcinoma of the base of tongue. Methods and Materials: Between April 1975 and December 1993, 41 patients with base-of-tongue carcinomas were treated with 192Ir interstitial implants after EBRT at Stanford University. One patient had Stage I, 6 had Stage II, 7 had Stage III, and 27 had Stage IV tumors. Twenty-eight patients had cervical lymph node involvement at diagnosis. All received EBRT to a median dose of 50 Gy (range 48.9-68 Gy) to the primary tumor and regional lymph nodes before brachytherapy. Interstitial implant was performed 2-4 weeks after EBRT. Intraoperatively, nylon catheters were placed via steel trocars into the base of tongue, glossotonsillar groove, and pharyngo-epiglottic fold using a catheter looping technique. Twenty-three of 28 node-positive patients also underwent simultaneous neck dissections. Postoperatively, the 192Ir seeds were inserted and allowed to remain in place for approximately 35 h to achieve a median tumor dose of 26 Gy (range 20-34 Gy) to a median volume of 73 cc. Survival, local control, and complications were assessed. Results: With a median follow-up of 62 months (range 9-215) for all patients and 90 months for alive patients, the 5-year Kaplan-Meier survival estimate was 66%. The 5-year local control rate was 82%, with 7 patients recurring locally, 2 of whom were salvaged with surgery. Nodal control was achieved in 93% of patients with either EBRT alone or in combination with neck dissection. The 5-year freedom from distant metastasis rate was 83%. Acute complications included transient bleeding (5%) and infection (8%). Late complication included soft-tissue necrosis/ulceration (7%), osteoradionecrosis (5%), and xerostomia. Conclusion: Base-of-tongue carcinoma can be effectively treated with EBRT and 192Ir implant boost. Local control is excellent and complication rates are acceptable.

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