Brachytherapy or stereotactic body radiotherapy boost for early-stage oropharyngeal cancer: Comparable outcomes of two different approaches

Objectives To compare outcome, toxicity and QoL of two boost modalities for T1-2 oropharyngeal carcinoma (OPC). Materials and methods Between 2000 and 2012, 250 consecutive patients with T1-2N0-3 were treated with 46-Gy of IMRT followed by boost using brachytherapy (BTB) or stereotactic body radiotherapy (CKB). Endpoints were local control (LC), disease-free survival (DFS), overall survival (OS), toxicity and prospective QoL-assessment. Results The 3-year actuarial incidence of LC were 97% and 94% for the CKB and BTB, respectively (p = 0.33). The figures for DFS were 92% and 86% (p = 0.15) and for OS were 81% and 83% (p = 0.82), respectively. The incidence of tube feeding were 17% and 20%, respectively (p = 0.47). The figures for grade ≥2 late dysphagia were 11% and 8% (p = 0.34) and for xerostomia were 16% and 12% (p = 0.28), respectively. For both modalities, clinically relevant deteriorations were seen on all scales at end of treatment but the scores returned to almost baseline levels within 6-12 months, with exception of QLQ-H&N35-xerostomia. The difference on that scale was neither statistically significant nor clinically relevant between both modalities. Conclusion Comparable outcome, toxicity and QoL-scores were achieved with both modalities. In the light of the logistical hassle around the implantation, the need of dexterity, and the risk of anaesthesia and peri-operative complications associated with BTB, CKB might be regarded as the optimal option to boost early-stage OPC. However, in radiotherapy departments where no facilities are available for stereotactic radiotherapy, BTB is an elegant option to achieve excellent outcome with low toxicity profile and good QoL.