An original technique of brachytherapy in the treatment of epidermoid carcinomas of the buccal mucosa.

PURPOSE

To report our experience using brachytherapy in buccal mucosa carcinoma with particular attention on the technique of implantation used and on the elective treatment to the lymph nodes.

METHODS AND MATERIALS

From 1973 to 1991, 42 patients (36 T1 T2 T3, 35 NO) were treated for epidermoid carcinoma of the buccal mucosa as the first site of head and neck cancer. To study the local control, the group of 36 T1-3 patients was divided into two groups according to the brachytherapy technique used: the parallel wires technique and the loop technique (M. Pernot). The latter consists of making a loop of Iridium wire encircling the tumor, the curved part acting as a barrier for the posterior part of the cheek (site of recurrence). The group of 35 NO patients was individualized to evaluate the necessity of an elective node treatment. Twenty-three patients had no elective treatment to node areas, 8 an external radiotherapy, and 4 a neck dissection.

RESULTS

Overall survival of these 42 patients was 63% at 2 years and 47.5% at 5 years. Specific survival was 77.5% at 2 years and 73.6% at 5 years. Survival without recurrence was 58% at 2 years and 54% at 5 years. Eighty-three percent of the recurrences occurred during the first year. There were six local recurrences on the 14 T1-3 patients treated with the parallel wires technique and 1 on the 22 T1-3 patients treated with the loop technique (6 out of 7 in the posterior part of the buccal mucosa). The local control at 5 years was 91% with the loop technique vs. 58% with the parallel wires technique (p = 0.01). Among the 23 NO patients with no elective treatment, 6 had a nodal failure (5 T2 and 1 T1 of 2 cm). Out of the 8 NO patients treated by radiotherapy, 3 had a nodal failure. The four NO patients treated by surgery were controlled.

CONCLUSION

Brachytherapy using the loop technique is the local treatment of choice for tumors < or = 5 cm. Elective treatment of the neck lymph nodes is required in patients with a lesion > 1 cm and neck dissection may be preferable to external radiotherapy.