Brachytherapy (Interventional Radiotherapy) for lip carcinoma: excellent local control, low toxicity profile, and high patient satisfaction – The Dutch experience from four brachytherapy-dedicated head and neck cancer centers

Purpose: The aim of this study is to evaluate oncologic outcomes, toxicity, and patient satisfaction after brachytherapy (interventional radiotherapy) for lip carcinoma at four brachytherapy-dedicated Dutch head-and-neck cancer centers. Materials and methods: Between 2009 and 2023, 272 patients with lip carcinoma were treated with high-dose-rate (HDR) or pulsed-dose-rate (PDR) brachytherapy, either primary (83%) or adjuvant (17%). The study endpoints were local and loco-regional control, acute and late toxicity, and patient satisfaction. Results: In the entire cohort, 38 recurrences were reported in 31 patients (11.4%). These were nine local (3.3%), 22 regional (8.1%) and seven distant failures (2,6%). Most of these failures were successfully treated, resulting in ultimate local and regional control rates of 99.6 % and 98.9 %, respectively. After median follow-up of 36 months, the 5-years actuarial local control rate for the entire group was 97%. The rates for primary and adjuvant brachytherapy were 96% and 100% (p = 159) and for HDR and PDR were 98% and 94% (p = 671), respectively. All patients developed acute mucositis, which healed within three months. Delayed healing was observed in 4% of patients, and only 2.2% experienced grade 2 late toxicity. On three-points Likert scale for patients satisfaction (available from 81 patients), 80% was very satisfied (score 9–10), 18% satisfied (score 7–8) and only one patient was unsatisfied. Only 7.4% of patient had a satisfaction score of ≤ 7; 25% of them had received adjuvant, compared to 3% who received primary brachytherapy (p = 0.002). Conclusions: In the largest study to date, brachytherapy for lip carcinoma resulted in excellent local control, a favorable toxicity profile, and high level of patient satisfaction as well for those treated in the primary as in adjuvant settings.