Postoperative brachytherapy in the treatment of the early oral cancer

2 Summary Purpose: Evaluation of the postoperative high-dose-rate brachytherapy (HDR BT) in the treatment of early oral cancer and factors influencing tumour control. Material and methods: Thirty patients with T1-T3N0 tongue and floor of mouth cancer were treated with tumour excision elective neck dissection and HDR BT 18 x 3 Gy bid. The Kaplan- Meier model was used for survival analyses and the log-rank test and Cox regression analyses were used to evaluate the influence of T-stage, histological grade, resection margin, depth of invasion, and vascular endothelial growth factor (VEGF) intensity on local control (LC), nodal control (NC), disease-free survival (DFS) and overall survival (OS). Median follow up was 40 months (6 - 145). Results: Actuarial 5 year LC, NC, DFS, DFS after salvage treatment and OS were 85.4%, 69.2%, 65.4%, 75.6% and 73.0%, respectively. The log-rank test and univariate Cox regression analysis revealed the following correlations: tumour grade correlated with LC, DFS and OS; T- stage with NC and DFS; depth of invasion and VEGF intensity with NC, DFS and OS. Associations detected on the multivariate analysis were as follows: tumour grade with LC; depth of invasion with NC; depth of invasion and tumour grade with DFS; and VEGF intensity with DFS after salvage treatment. Only one case of..

Is There Still a Place for Brachytherapy in the Modern Treatment of Early-Stage Oral Cancer?

Brachytherapy (BT) involves the direct application of radioactive sources to the tumour. This technique is characterised by a steep dose gradient, the delivery of high-dose radiation to the target volume centre, and the sparing of surrounding healthy tissues. Low-dose-rate (LDR) BT and manual afterloading played an important role in the treatment of early-stage oral cancer, with treatment outcomes that were comparable to surgery. Interest in BT as a primary treatment for oral cancer has declined in recent years due to the emergence of better surgical techniques, the switch from LDR BT to high-dose-rate (HDR) BT (which has a higher risk of complications), and to advances in external beam radiotherapy (EBRT). At present, the main indications for BT are in the postoperative setting due to the superior dose conformity and better quality of life offered by BT versus EBRT. Postoperative BT can be administered as monotherapy in early-stage (T1N0) cancers and in combination with elective neck dissection or EBRT to treat larger or deeper tumours. BT yields excellent results for lip carcinoma in older patients and in tumours with unfavourable localisations. BT is an effective salvage therapy for local recurrences in previously-irradiated areas. Despite its many advantages, brachytherapy is a complex treatment requiring meticulous technique and close cooperation between the radiation oncologist, physicist, and surgeon

Deep Neck Infections of Odontogenic Origin and Their Clinical Significance. A Retrospective Study from Hradec Králové, Czech Republic

Introduction: Cellulitis remains a very serious disease even today. Mortality, which varied between 10–40%, has been reduced owing to the standard securing of airway patency and use of an appropriate surgical treatment approach. Materials and methods: A total of 195 patients were hospitalised for cellulitis at the University Hospital in Hradec Králové during 2007–2011. The following parameters were evaluated: age, gender, dependence of incidence of the disease on the season of the year, frequency of attacks of the particular areas and their clinical characteristics, aetiology of the inflammation, types of patient complaints, prevalence of current systemic diseases, results of microbiological and selected laboratory analyses, socio-economic status of the patients, and duration of patient stay at the hospital. Statistical analysis was performed by using Pearson’s correlation coefficient, the statistical significance level was p < 0.05. Results: The mean age of the patients was 39.8 years. The group of 195 patients included 108 (55%) males and 87 (45%) females. The mean time between the first symptoms of the disease and admission to the Department was 5 days. From among the 195 patients, 116 (59.5%) were working persons, 79 (40.5%) were non-working (children, students, unemployed persons, women on maternity leave, retired people). The odontogenic origin of the disease was verified in 173 (88.7%) patients. In total, 65 (33.3%) patients had no coinciding complicating systemic disease, 22 (11.3%) patients had diabetes mellitus. The most frequent symptom of cellulitis was painful swelling, found in 194 (99.5%) patients, followed by jaw contracture, found in 153 (78.5%) patients. Conclusion: The results are largely very similar to those of previous studies performed in other countries, except that we found no correlation between the prevalence of cellulitis and the socio-economic status, nor have we confirmed Klebsiella pneumoniae sp. as the cause of cellulitis in patients with diabetes mellitus

Is There Still a Place for Brachytherapy in the Modern Treatment of Early-Stage Oral Cancer?

Brachytherapy (BT) involves the direct application of radioactive sources to the tumour. This technique is characterised by a steep dose gradient, the delivery of high-dose radiation to the target volume centre, and the sparing of surrounding healthy tissues. Low-dose-rate (LDR) BT and manual afterloading played an important role in the treatment of early-stage oral cancer, with treatment outcomes that were comparable to surgery. Interest in BT as a primary treatment for oral cancer has declined in recent years due to the emergence of better surgical techniques, the switch from LDR BT to high-dose-rate (HDR) BT (which has a higher risk of complications), and to advances in external beam radiotherapy (EBRT). At present, the main indications for BT are in the postoperative setting due to the superior dose conformity and better quality of life offered by BT versus EBRT. Postoperative BT can be administered as monotherapy in early-stage (T1N0) cancers and in combination with elective neck dissection or EBRT to treat larger or deeper tumours. BT yields excellent results for lip carcinoma in older patients and in tumours with unfavourable localisations. BT is an effective salvage therapy for local recurrences in previously-irradiated areas. Despite its many advantages, brachytherapy is a complex treatment requiring meticulous technique and close cooperation between the radiation oncologist, physicist, and surgeon