Parthasarathy Vedasoundaram
Additional Professor a JIPMER
Title: Role of high dose rate Brachytherapy in early and locally advanced squamous cell carcinoma of oral cavity
Biography
Biography: Parthasarathy Vedasoundaram
Abstract
Background: The study was intended to assess the effect of high dose rate brachytherapy in early and locally advanced squamous cell carcinoma of oral cavity for local control, toxicity and functional outcome. Materials & Methods: 125 Eligible patients with mean age of 53.91 years (Range 32-73 years) were included in this study from November 2008 to June 2015. Follow-up period ranged from twelve months to eighty four months with median follow up period of 48 months. 68/125 patients were with early stage oral cancer (I & II) and 57/125 patients were with locally advanced stage (III & IVA). 60% had anterior 2/3rd tongue lesion, 34.4% buccal mucosa and 5.6% had lesions in the floor of mouth. Stage I (T1N0M0) patients received primary brachytherapy alone. Dose ranged from 38.5Gy to 42Gy (3.5Gy/# to 3Gy/#) twice daily with 6 hours interval between two fractions for 11 to 14#s. 110 patients received External beam radiation alone or concurrent chemoradiation (50Gy) where ever appropriate for their stages, Chemotherapy dose being Injection Cisplatin 70mg/m2, along with HDR interstitial Brachytherapy boost (3-3.5Gy per fraction × 6-7 fractions-twice daily). Results: Of the 125 patients, 103/125 showed complete response (82.4%) and 22/125 (17.6%) were found to have residual tumor during follow up. 11 patients died. Four patients died due to other causes. Two patients had sudden myocardial infarction and died. One patient developed sputum positive pulmonary tuberculosis after three years of post-radiotherapy period. He developed massive hemoptysis and died. One patient developed second primary in brainstem. He became quadriplegic and ultimately died. Seven patients died of disease progression. Those with residual diseases on follow up (Biopsy proven) were referred to surgical oncology department for salvage surgery. About 100% in stage I, 83% in stage II, 78% in stage III, 50% in stage IVA had local control. 5 patients developed bleeding at time of implant catheter removal after brachytherapy treatment which was effectively managed by compression for few minutes and ice packs. None of them required surgical intervention or blood transfusion. Soft tissue necrosis developed in 7 patients and 2 patients were sent for surgical intervention. 6 patients developed Osteoradionecrosis of them, one patient required surgery.