Interstitial HDR Brachytherapy in head and neck carcinomas: experience in COVID pandemic
PD-0559
Abstract
Interstitial HDR Brachytherapy in head and neck carcinomas: experience in COVID pandemic
Authors: Aman Sharma1, Rampukar Bharat2, Vibhay Pareek2, Abiramasundari Vivekanandan2, Gopikrishna Shyam2, Vivek Gosh2, Shipra Gupta2, Jyoti Yadav3, Shreejesh Mullassery3, Raaj Kishor Bisht3, Pritee A. Patil2, Supriya Mallick2, Daya Nand Sharma2, Sushant Nirala4
1NCI, AIIMS-JHAJJAR, RADIATION ONCOLOGY, JHAJJAR, India; 2NCI, AIIMS-JHAJJAR, Radiation Oncology, Jhajjar, India; 3NCI, AIIMS-JHAJJAR, Medical Physics, Jhajjar, India; 4NCI, AIIMS-JHAJJAR, Radiation oncology, Jhajjar, India
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Purpose or Objective
Brachytherapy is the best conformal form of radiation delivery. We herein present High-dose rate (HDR)
brachytherapy dosemetric and clinical outcomes performed during the covid pandemic.
Material and Methods
Interstitial brachytherapy was performed in 19 patients head and
neck carcinomas from May 2020 to August 2021. All patients were discussed in multidisciplinary tumor board. EBRT
to elective neck was 45Gy in 20 fractions or 50/50,4 Gy in 25/28 fractions. Patients
with positive lymph nodes were given SIB-IMRT of 56.26-58.25 Gy in 25 fractions
(suspicious sub centimetric nodes) or 63 or 65 Gy in 28 fractions to the involved
nodes (> 1cm). Double plane implant was performed in all patients (square or
triangular geometry).
Results
Sixty-eight per cent were subjected to radical
treatment, 16% to adjuvant and 16% were re-irradiated. Majority 68% of the
patients were anterior tongue lesions, remaining included buccal mucosa (21%)
and floor of mouth (11%) lesions. The median catheter placement was 8 catheters
(range 5-9 catheters). Square implants were performed in 37% whereas remaining 63% were
subjected to triangular implants.
All patients in radical setting received a boost of
either 24 Gy (85%) or 21 Gy (15%) in 8-7 fractions, 2 fractions a day at least
6 hours apart. Thirty-eight of these patients has lymph node involvement. In reirradiation
setting brachytherapy alone was delivered in 42 Gy/12 fractions /6 days. In
adjuvant setting brachy dose was 40-44 Gy in 10-11 fractions over 5/5.5 days. Median
V 200 was 2.96cc (range 1.45-5.7cc), V150 median was 6.42cc (range 3.6-12cc) &
V100 median was 25.5 cc (range 10-39.7cc). Median Dose non-uniformity ratio (DNR) was 0.26
(range 0.23-0.40). At a median follow of 35 days (range 0-465 days) all patients
are disease free. No patient developed COVID infection before, during or after
brachytherapy implant.
Conclusion
HDR brachytherapy is treatment option for head
and neck carcinoma patients in radical, adjuvant and reirradiation setting. In the
present study good dosemetric outcomes (median DNR of 0.26 and median V
200 of 3cc) were achieved. Longer follow up is required to confirm our findings
as regards to efficacy and toxicity outcomes.