Interstitial brachytherapy as boost for locally advanced T4 XXXX .

@entity1 @entity135 @entity957 @entity902
PURPOSE: Locally advanced @entity135 ( @entity135 ) with bone and cartilage invasion (BCI) or those with soft-tissue invasion (STI) have been treated with resection followedup with chemoradiotherapy (CRT) or definitive CRT. However, locoregional recurrence remained a large component of treatment failure. High-dose-rate interstitial brachytherapy (BT) has been used for dose escalation to further prevent local relapse. This is a review of our experience. METHODS AND MATERIALS: T4N0-3M0 locally advanced oral cavity and @entity957 ( @entity957 ) @entity1 underwent definitive CRT or radiotherapy (RT) followedup with brachytherapy (BT). RT doses ranged from 45 to 50.4Gy. The @entity1 were reassessed at this dose and if response was inadequate, @entity1 underwent BT. BT doses ranged from 24 to 30Gy at 3-4Gy per fraction BID with 6h in between fractions. Concurrent chemotherapy was @entity902 based. RESULTS: Twenty @entity1 were treated with CRT or RT alone followed by BT. Thirteen @entity1 had STI and 7 had BCI; 14 @entity1 were treated with CRT followed by BT; and 6 @entity1 were treated with RT alone followed by BT. Five-year locoregional control was 61%. Five-year overall survival was 29%. When we excluded the @entity1 treated with RT alone, 5-year overall survival was 36%. Nodal status was the only prognostic factor. CONCLUSIONS: This study suggests CRT followedup with BT for @entity1 with T4 locally advanced @entity135 of the oral cavity, and oropharynx is a feasible treatment option. In @entity1 with poor response to CRT, BT may be used for dose escalation to increase locoregional control.
