Top Line: Is head and neck brachytherapy ready for a comeback?
The Study: We’ve seen clinically meaningful reductions in dose-fall off with intensity modulated radiation (IMRT) to spare parotid glands, but it may be hard to rival that of century-old brachy techniques. This prospective trial randomized 90 patients receiving definitive radiation for T1-2N0 squamous cell carcinoma of oropharynx to standard IMRT 70 Gy in 35 fractions versus IMRT 50 Gy in 25 fractions followed by an interstitial brachytherapy boost with using HDR (Ir-192) to a dose of 21 Gy in 7 twice-daily fractions. Brachy was done under general anesthesia with needles inserted from the submental/ submandibular region. Among the 70 patients evaluated at 6 months, the primary endpoint of xerostomia as measured quantitatively by 99mTc salivary scintigraphy occurred in 14/32 (44%) in the standard arm versus 5/35 (14%) in the brachy arm. Physician-reported grade 2+ xerostomia was also slashed from 9/30 (30%) to 2/30 (7%). Interestingly, there was also quite the discrepancy in 3-year local control in the per protocol analysis: 71% with brachy versus 54% without—the authors attribute low overall rates of local control to a preponderance of HPV- tumors and heavy tobacco use.
TBL: “The addition of brachy to IMRT for the treatment of T1-T2N0M0 oropharyngeal cancers results in a significant reduction in xerostomia.” | Budrukkar, Int J Radiat Oncol Biol Phys 2023
The Study: We’ve seen clinically meaningful reductions in dose-fall off with intensity modulated radiation (IMRT) to spare parotid glands, but it may be hard to rival that of century-old brachy techniques. This prospective trial randomized 90 patients receiving definitive radiation for T1-2N0 squamous cell carcinoma of oropharynx to standard IMRT 70 Gy in 35 fractions versus IMRT 50 Gy in 25 fractions followed by an interstitial brachytherapy boost with using HDR (Ir-192) to a dose of 21 Gy in 7 twice-daily fractions. Brachy was done under general anesthesia with needles inserted from the submental/ submandibular region. Among the 70 patients evaluated at 6 months, the primary endpoint of xerostomia as measured quantitatively by 99mTc salivary scintigraphy occurred in 14/32 (44%) in the standard arm versus 5/35 (14%) in the brachy arm. Physician-reported grade 2+ xerostomia was also slashed from 9/30 (30%) to 2/30 (7%). Interestingly, there was also quite the discrepancy in 3-year local control in the per protocol analysis: 71% with brachy versus 54% without—the authors attribute low overall rates of local control to a preponderance of HPV- tumors and heavy tobacco use.
TBL: “The addition of brachy to IMRT for the treatment of T1-T2N0M0 oropharyngeal cancers results in a significant reduction in xerostomia.” | Budrukkar, Int J Radiat Oncol Biol Phys 2023