Brachytherapy (Interventional Radiotherapy) for lip carcinoma: excellent local control, low toxicity profile, and high patient satisfaction - The Dutch experience from four brachytherapy-dedicated head and neck cancer centers.

Abstract

The aim of this study is to evaluate oncologic outcomes, toxicity, and patient satisfaction after brachytherapy (interventional radiotherapy) for lip carcinoma at four brachytherapy-dedicated Dutch head-and-neck cancer centers. Between 2009 and 2023, 272 patients with lip carcinoma were treated with high-dose-rate (HDR) or pulsed-dose-rate (PDR) brachytherapy, either primary (83%) or adjuvant (17%). The study endpoints were local and loco-regional control, acute and late toxicity, and patient satisfaction. In the entire cohort, 38 recurrences were reported in 31 patients (11.4%). These were nine local (3.3%), 22 regional (8.1%) and seven distant failures (2,6%). Most of these failures were successfully treated, resulting in ultimate local and regional control rates of 99.6 % and 98.9 %, respectively. After median follow-up of 36 months, the 5-years actuarial local control rate for the entire group was 97%. The rates for primary and adjuvant brachytherapy were 96% and 100% (p = 159) and for HDR and PDR were 98% and 94% (p = 671), respectively. All patients developed acute mucositis, which healed within three months. Delayed healing was observed in 4% of patients, and only 2.2% experienced grade 2 late toxicity. On three-points Likert scale for patients satisfaction (available from 81 patients), 80% was very satisfied (score 9-10), 18% satisfied (score 7-8) and only one patient was unsatisfied. Only 7.4% of patient had a satisfaction score of ≤ 7; 25% of them had received adjuvant, compared to 3% who received primary brachytherapy (p = 0.002). In the largest study to date, brachytherapy for lip carcinoma resulted in excellent local control, a favorable toxicity profile, and high level of patient satisfaction as well for those treated in the primary as in adjuvant settings.