Squamous cell carcinoma of the oral tongue and floor of mouth. Evaluation of interstitial radium therapy.

From January, 1965, to December, 1972, 46 patients with squamous cell carcinoma of the floor of the mouth and 102 patients with squamous cell carcinoma of the oral tongue were treated at M.D. Anderson Hospital and Tumor Institute by interstitial irradiation alone or in combination with external irradiation. Through the years the combination of radiation therapy modalities has been adjusted in an attempt to improve local control, keeping complications to a minimum. In this paper we analyze local control, causes of failure and complications as related to the primary size (T stage) and radiation therapy techniques employed.     

A comparison of treatments of squamous cell carcinoma of the base of tongue: surgical resection combined with external radiation therapy, external radiation therapy alone, and external radiation therapy combined with interstitial radiation

PURPOSE: The outcomes of patients treated at a single institution over a specific time frame using three different therapeutic approaches for cancer of the base of tongue were reviewed. METHODS AND MATERIALS: Between 1992 and 1998, 53 patients were treated with curative intent for base of tongue cancer. Seventeen patients underwent surgical resection with postoperative radiation therapy, 16 patients received definitive external radiation therapy only, and 20 patients were treated with external and interstitial radiation, with neck dissection in 16 of those patients. Local control, survival, and functional status were assessed with each approach. RESULTS: The 5-year actuarial local control and survival for the surgically treated patients were 74% and 44%, respectively. The patients treated with external radiation therapy alone had local control of 28% and 5-year survival of 24%. The patients treated with external and interstitial radiation with neck dissection as indicated had 5-year actuarial local control of 87% and survival of 33%. Survival was not statistically different between the three treatment approaches (p=0.0995) but local control was worse in the definitive external radiation group (p < 0.0001). Speech and swallowing function among the long-term survivors was superior in the definitively irradiated patients compared with the operated patients. CONCLUSION: In this retrospective analysis, survival and local control was lowest in the patients treated with external radiation alone, however, patient selection likely played an important role. Local control was far better with surgical treatment and with external combined with interstitial radiation but survival remains less than 50% with each approach. Surgical treatment was superior for patients with T4 disease. Functional status was higher in the long-term survivors treated nonsurgically.     

Efficacy of high-dose-rate interstitial brachytherapy in patients with oral tongue carcinoma

PurposeTo evaluate the results of high-dose-rate (HDR)-interstitial brachytherapy (ISBT) in oral tongue carcinomas.Methods and MaterialsBetween September 1999 and August 2007, 50 patients were treated for oral tongue carcinoma with HDR-ISBT. The patient's mean age was 58 years. Forty-two patients were in T1–2 stage and 8 patients were in T3 stage; 16 patients were in N+ stage and 34 patients in N0 stage. Exclusive ISBT was given to 17 patients (34%) in T1–2 N0 stage and complementary to external beam radiotherapy (EBRT) to 33 patients (66%). A perioperative technique was performed on 14 patients. The median total dose was 44 Gy when HDR was used alone (4 Gy per fraction) and 18 Gy when complementary to 50 Gy EBRT (3 Gy per fraction).ResultsThe median followup was 44 months. Actuarial disease-free survival rates at 3 and 5 years were 81% and 74%, respectively. Local failure developed in 7 patients. Actuarial local control (LC) rates were 87% and 79% at 3 and 5 years in T1–2 stage 94.5% and 91% and T3 stage 43% and 43% (with salvage surgery). Exclusive HDR cases showed LC in 100% of the cases, and the combined group (EBRT + HDR) showed LC in 80% and 69% of the cases at 3 and 5 years (p = 0.044). Soft-tissue necrosis developed in 16% and bone necrosis in 4% of the cases.ConclusionsHDR brachytherapy is an effective method for the treatment of oral tongue carcinoma in low-risk cases. Doses per fraction between 3 and 4 Gy yield LC and complication rates similar to low-dose rate. The perioperative technique promises encouraging results.     

Time, dose and volume factors in interstitial Radium implants of carcinoma of the oral tongue.

In a retrospective computer dosimetry analysis of 58 patients with carcinoma of the oral tongue treated with interstitial radium implants alone or in combination with external irradiation, dose and volume appear to be the most important factors in both local control and the incidence of necrosis; in the dose rate range commonly used in clinical interstitial radiotherapy, dose rate has no significant effect. The optimal minimum tumor doses for local control vary with the size of the primary lesion: 6,000 rads for T1 lesions and 6,500 rads for T2 lesions treated with interstitial radium implants alone and 7,500 rads for lesions treated with interstitial radium implants in combination with external irradiation. For lesions treated with implants plus external irradiation, greater local control was achieved when most of the dose was delivered through the interstitial implants. For a given volume, the incidence of necrosis was directly proportional to the degree of overdosage; for a given dose, the incidence of necrosis was directly proportional to the volume receiving the dose.     

Preliminary experience with interstitial radiation, interstitial hyperthermia and interstitial photodynamic therapy in a simple animal model

This paper deals with interstitial radiation therapy (RT), interstitial hyperthermia (HT) and interstitial photodynamic therapy (PDT). Its main focus, however, is to describe a single animal model in which the interaction of these three modalities, when applied by interstitial techniques, can be studied. To serve this purpose a special template was designed by which the parallel interaction of catheters (sources) with a fixed spacing was facilitated. If necessary, radiation sources could be fixed into the tumor during the computed treatment time. The applicability of this simple design is demonstrated by the preliminary findings of two conducted pilot studies, that is with the combination of interstitial PDT + HT and the combination of interstitial HT + RT.     

Radiotherapy of carcinoma of the prostate--5 years' experience

Forty three patients were treated for cancer of prostate by irradiation at the Radiotherapeutic Ward of the Research Institute of Clinical and Experimental Oncology in the years 1976 to 1981. The five-year period of survival in patients with a localized tumorous disease was 45%. The authors analyzed causes of unsuccessful therapy and evaluated complications of the therapy, the latter being mostly early postirradiation reactions. Possibilities of improving the results of treatment in optimizing the radiotherapy of the localized prostate cancer are outlined.     

A review of 25 years' clinical application of fast electrons in radiation therapy (author's transl)

The first betatron developed for current use of fast electrons in radiation therapy (15 MeV, Siemens) has been installed at the Dermatologische Klinik der Universit?t G?ttingen in 1952 (Bode, Markus). The first human carcinoma treated with fast electrons was irradiated using the first 6-MeV-betatron (Dr. Gund, Siemens) at the 2nd institute of physics of the G?ttingen university (Bode, Kopfermann, Paul, 1949). Characteristics of the electron radiation utilized for treatment and its particular advantages in dermatological radation therapy are reported. Two clinical examples, one of them the first human carcinoma irradiated with fast electrons, are described, and the frequency distribution of the indications for electron therapy at the dermatological clinics of the university is tabulated for a total of 3419 cases treated between 1949 and 1972 (Bode et al.).     

Combined isodose curves of high-dose rate interstitial brachytherapy with external-beam radiation therapy in pancreatic carcinoma.

From September 1989 until March 1992 nine patients with unresectable, though localized carcinoma of the pancreas were treated by a multimodality therapy consisting of palliative surgery, interstitial conformal brachytherapy in high-dose rate mode (HDRBT) with iridium-192 up to 30 Gy and external-beam radiation therapy (EBRT) of about 52 Gy. Four patients simultaneously received two cycles of chemotherapy consisting of 5-FU and Leucovorin. Since high radiation doses are applied which are not tolerated in adjacent healthy tissues, doses to tumor and critical areas need to be known precisely and are to be adjusted before treatment. A three-dimensional imaging system is required. A self developed method combines the data of simulation radiographs and those of CT scans. The prescribed minimum target absorbed dose in HDRBT is adjusted to the target volume sparing organs at risk. The specialized quality assurance is adapted to this method. Differences between measured and calculated doses do not exceed 5%. The addition of isodoses of HDRBT and EBRT on CT scans is demonstrated. Due to patients' selection the treatment concept did not reveal any positive effects on survival. However, excellent palliative results were obtained without severe side-effects.     

Adenoid cystic carcinoma of the tongue base treated with ultrasound-guided interstitial photodynamic therapy: a case study

Adenoid cystic carcinoma is a malignant neoplasm arising from the salivary glands. It accounts for 10-15% of all salivary gland neoplasms, representing 1-2% of malignant neoplasms of the head and neck. It is characterized by slow growth, diffuse invasion and potential to produce distant metastases, mainly to the lungs and bone. We present a case of adenoid cystic carcinoma of the base of tongue treated with ultrasound guided transcutaneous interstitial photodynamic therapy (PDT) as a salvage treatment.     

Treatment of carcinoma of base of tongue with radiation therapy and 5-fluorouracil. Potential for optimization with 18F-FU.

The treatment of advanced base of tongue carcinoma with concurrent radiation therapy and 5-fluorouracil versus radiation therapy alone is compared. Although the results are inconclusive, it is noteworthy that all the 5-year survivors were patients given combined treatment. Important questions regarding optimization of time-dose relationships with combined therapy were generated. Accordingly, 18F-5 fluorouracil was synthesized in an attempt to answer some of these questions.