Brachytherapy boost: A novel approach for epiglottic carcinoma

Purpose Epiglottic (epilaryngeal) carcinoma has been treated conventionally by radical external beam radiotherapy or partial laryngectomy. The aim of this study is to evaluate the role of brachytherapy boost as a novel approach for lingual epiglottic lesions. Methods and materials Twenty-three patients with T2–3N0–1 lingual epiglottic carcinoma (SCC) were treated with curative intent between January 1990 and December 2001 using low dose rate interstitial 192Ir implant boost, moderate dose of 25 Gy at 0.5 cm (mean dose rate, 50.5 cGy/h) 3 weeks after moderate dose of external beam radiotherapy (mEBRT) of 46 Gy/23#/28–31 d. Results Complete response after mEBRT was observed in 18 of the 23 patients (78%) and partial response was seen in 5 of the 23 patients (22%). After implant, all patients had complete response. Locoregional control was seen in 19 of the 23 patients (82.6%). Two patients developed distant metastases. Disease-free survival and overall survival at 5 years were 68.3% and 66.7%, respectively. Disease-free survival at 5 years showed a trend toward better outcome for biologically equivalent doses >85 Gy compared with biologically equivalent doses <85 Gy (80% vs. 68%) (p = 0.18). All patients had minimal to acceptable xerostomia. Conclusions Interstitial boost with mEBRT is feasible, effective, and a novel approach for lingual epiglottic lesions.