Brachytherapy for head and neck cancers [Curiethérapie des cancers des voies aérodigestives supérieures]

摘要

The main indications of brachytherapy for head and neck cancers are limited tumours of the oral cavity, the oropharynx and the nasopharynx. This technique can be exclusive, associated with external radiotherapy or postoperative. This is also a treatment for second localizations in previously irradiated areas. If low-dose rate brachytherapy is the reference, the pulse dose rate brachytherapy by control of the dose rate and optimisation of the dose distribution is the technique to be preferred. High-dose rate brachytherapy is an option. The major prognosis factors of local control and complications are the use of a leaded protection of the mandible, the intersource spacing (1.2-1.4cm), the volume treated (30cm3, i.e. three loops), the safety margin (5mm), the dose rate (0.5Gy/h), the total dose (65Gy in case of exclusive brachytherapy, 25Gy in case of a combination of external beam irradiation [50Gy] and brachytherapy in the oropharyngeal carcinomas, 35Gy in case of a combination of external beam irradiation [40Gy] and brachytherapy in the oral cavity carcinomas, 60Gy in case of a second localization in previous irradiated tissues), the delay between external irradiation and brachytherapy (20days), the dose per fraction and the treated volume for high-dose rate brachytherapy. Brachytherapy, when possible, is the optimal method of irradiation of head and neck carcinomas with limited volume.