High dose rate brachytherapy using molds after chemoradiotherapy for oral cavity cancer

The aim of this study was to investigate the role of the combined use of customized molds and a high dose rate (HDR) remote afterloading brachytherapy apparatus with a Ir-192 microsource in the treatment of superficial oral carcinomas after chemoradiotherapy. Nine patients with oral squamous cell carcinoma who were treated using this combined technique were analyzed retrospectively. The primary sites of the tumors were the mouth floor, gingiva, and soft palate. For each patient, a customized mold was fabricated in which 2-3 afterloading catheters were placed for the Ir-192 source. Three to eight fractions of 3 Gy, 5 mm below the mold surface, were given following external radiotherapy of 24-50 Gy/2 Gy combined with chemotherapy (peplomycin or taxotere). The total dose of HDR brachytherapy ranged from 9 to 24 Gy. The 2-year local control probability was 100% and the 2-year cause-specific survival rate was 100%. No serious complications (i.e., ulcer or bone exposure) have been observed thus far during the follow-up period of 29-120 months. HDR brachytherapy using the mold technique after chemoradiotherapy is a safe and excellent method for selected early and superficial oral cavity cancers.