AN ORIGINAL TECHNIQUE OF BRACHYTHERAPY IN THE TREATMENT OF EPIDERMOIDCARCINOMAS 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 treatement to the lymph nodes. Methods and Ma terials: From 1973 to 1991, 42 patients (36 T1 T2 T3, 35 N0) were trea ted 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 encirc ling the tumor, the curved part acting as a barrier for the posterior part of the cheek (site of recurrence), The group of 35 N0 patients wa s individualized to evaluate the necessity of an elective node treatme nt. Twenty-three patients had no elective treatment to node areas, 8 a n external radiotherapy, and 4 a neck dissection, Results: Overall sur vival of these 42 patients was 63% at 2 years and 47.5% at 5 years, Sp ecific survival was 77.5% at 2 years and 73.6% at 5 years, Survival wi thout recurrence was 58% at 2 years and 54% at 5 years, Eighty-three p ercent of the recurrences occurred during the first year, There were s ix 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 t echnique (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 N0 patients with no elective treatment, 6 had a nodal failure (5 T2 and 1 T1 of 2 cm). Out of the 8 N0 patients treated by radiotherapy, 3 had a nodal failu re, The four N0 patients treated by surgery were controlled. Conclusio n: Brachytherapy using the loop technique is the local treatment of ch oice for tumors less than or equal to 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.