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Locally advanced verrucous carcinoma of the oral cavity

Treatment using customized mold HDR brachytherapy instead of hemi-maxillectomy

Lokal fortgeschrittenes verruköses Karzinom der Mundhöhle

HDR-Brachytherapie mit individueller Gussform als Alternative zur Hemimaxillektomie

  • Case study
  • Published:
Strahlentherapie und Onkologie Aims and scope Submit manuscript

Abstract

Background

Oral verrucous carcinomas are locally invasive but rarely metastasize. Current treatment options include surgery and external beam radiotherapy (EBRT). In medical inoperable patients or irresectable tumors, high-dose-rate (HDR) brachytherapy is a valid alternative.

Case

We present an 85-year-old man with functionally irresectable cT3N0M0 verrucous carcinoma superficially spreading along the upper alveolar ridge to the retro-alveolar triangle, with infiltration of the left soft and hard palate and buccal mucosa. Using a customized intraoral mold, this patient was treated with HDR brachytherapy delivering a dose of 48 Gy in 12 fractions three times per week. Treatment was well tolerated, and after prolonged confluent mucositis the tumor is in complete remission.

Review of literature and conclusion

The scarce literature on customized mold HDR brachytherapy in maxillary tumors is reviewed and recommendations for other head and neck tumors are given.

Abstract

Hintergrund

Verruköse Karzinome der Mundhöhle wachsen lokal invasiv, aber metastasieren selten. Behandlungsoptionen umfassen die chirurgische Tumorresektion und Teletherapie („external beam radiotherapy“, EBRT). Bei inoperablen Patienten oder irresektablen Tumoren ist die „High-dose-rate“-(HDR-)Brachytherapie eine mögliche Alternative.

Kasuistik

Wir präsentieren einen 85-jährigen Patienten in inoperablem Zustand mit einem funktionell irresektablen, verrukösen cT3N0M0-Karzinom, das sich entlang des Tuber maxillae zum Trigonum retro-molare hin ausbreitete und sowohl den weichen und harten Gaumen, als auch die Wangenschleimhaut infiltrierte. Mithilfe einer individuellen Gußform wurde der Patient mit HDR-Brachytherapie bis zu einer Gesamtdosis von 48 Gy in 12 Fraktionen 3-mal pro Woche behandelt. Die Radiotherapie wurde gut vertragen und nach einer langwierigen konfluenten Mukositis war der Tumor in kompletter Remission.

Literaturübersicht und Schlussfolgerung

Die nur in geringer Zahl vorhandene Literatur über HDR-Brachytherapie für Tumoren der Maxilla mithilfe einer individuellen Gussform wird besprochen und es werden Empfehlungen zur Indikation der HDR-Brachytherapie für andere Tumoren im Kopf-Hals-Bereich gegeben.

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Compliance with ethical guidelines

Conflict of interest. K.M.J van Gestel, D.J.M Buurman, R. Pijls, P.A.W.H. Kessler, P.L.A. van den Ende, A.L. Hoffmann, and E.G.C. Troost state that there are no conflicts of interest.

The accompanying manuscript does not include studies on humans or animals.

Consent was obtained from all patients identifiable from images or other information within the manuscript. In case of underage patients, consent was obtained from a parent or legal guardian.

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Authors and Affiliations

  1. Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, Dr Tanslaan 12, 6229 ET, Maastricht, The Netherlands

    K.M.J. van Gestel, R. Pijls, P.L.A. van den Ende, A.L. Hoffmann & E.G.C. Troost MD PhD

  2. Department of Cranio-Maxillofacial Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands

    D.J.M. Buurman & P.A.W.H. Kessler

Authors
  1. K.M.J. van Gestel
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  2. D.J.M. Buurman
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  3. R. Pijls
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  4. P.A.W.H. Kessler
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  5. P.L.A. van den Ende
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  6. A.L. Hoffmann
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  7. E.G.C. Troost MD PhD
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Corresponding author

Correspondence to E.G.C. Troost MD PhD.

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van Gestel, K., Buurman, D., Pijls, R. et al. Locally advanced verrucous carcinoma of the oral cavity. Strahlenther Onkol 189, 894–898 (2013). https://doi.org/10.1007/s00066-013-0412-4

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  • DOI: https://doi.org/10.1007/s00066-013-0412-4

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