This house believes that radiotherapy/brachytherapy should be considered for lip high risk non-melanoma skin cancer
SP-0091
Abstract
This house believes that radiotherapy/brachytherapy should be considered for lip high risk non-melanoma skin cancer
Authors: Ashwini Budrukkar1
1Tata Memorial Hospital, Department of Radiation Oncology, Mumbai, India
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Abstract Text
Management of periorificial tumours is
challenging due to its location and impact on functional and cosmetic outcome.
For early stage lip cancers single modality treatment either surgery or
radiation therapy (RT) is considered.
While for advanced disease combined modality treatment which includes
surgery, RT with or without chemotherapy is considered. Various surgical series
have reported excellent local control rates and overall survival in the range
of 65-90%. However the main issue with surgery is cosmetic and functional
impairment.
Brachytherapy with its ability to
deliver high dose to the tumour bed and rapid fall off of the dose beyond the
target appears to be a suitable method for treatment of lip cancers.
Brachytherapy for lip cancer is performed under anaesthesia. Typically 2 plane
implants are done with needles inserted in submucosal and subcutaneous planes.
This ensures adequate coverage of the target. There have been many series which
have used low dose rate brachytherapy (LDR) for lip cancers. All these series
have reported local control rates in the range of 75-95%. Additional advantage
of brachytherapy is preservation of
functional outcome as well as cosmetic outcome. These have a large impact on
quality of life of patients especially social interactions and eating in
public.
Since last 2 decades there has been
change from LDR to pulse dose rate (PDR) or high dose rate (HDR) brachytherapy.
HDR brachytherapy has an advantage of short treatment time, radiation
protection to the staff and convenience for the patients. Various fractionation
schedules have been used for treatment of lip cancer with dose per fraction
ranging from 3.5Gy to 5Gy per fraction. The local control rates of HDR series
are in the range of 85-95%. Although the data of HDR is limited, it has been
associated with lesser bone and soft tissue toxicity which has been one of the
major concerns with brachytherapy.
One of the drawbacks of brachytherapy is
the lack of management of neck. In situations where neck managements appears
necessary combined external beam RT and brachytherapy can be considered as on
option and has shown encouraging outcomes.
Overall brachytherapy appears to be an
excellent modality of treatment for management of lip cancers resulting in
comparable local control rates with surgery with better cosmetic and functional
outcomes. Hence brachytherapy should be considered as the standard of care and
surgery should be reserved for salvage in lip cancers.