A novel technique of brachytherapy for carcinoma of the buccal mucosa-Thinking out of the box!

PURPOSE: Brachytherapy(BT) can be used alone or in conjunction with external beam radiotherapy (EBRT) in the management of early head and neck cancers. Technical challenges may be encountered while planning implants for buccal mucosal cancers, which require customized solutions. We present the design and application of a customized 3D printed template for brachytherapy in one such case.

MATERIALS AND

METHODS

A 68 year old lady with an exophytic verrucous lesion of 2.5 × 2 cm in her left buccal mucosa refused to undergo surgical excision. She was planned for definitive Brachytherapy. The lesion being placed posteriorly and superiorly had a close proximity to the retromolar trigone and the upper gingivobuccal sulcus. This posed a technical challenge to place the implant in the regular parallel fashion, especially to provide adequate posterior and superior margins. Hence a perpendicular template based implant was planned. Three-dimensional (3D) Printing technology allows the creation of 3D physical objects from digital models using the additive manufacturing technology. A new template was created using 3D print technology customized to the patient's anatomy, to guide the placement of catheters in congruence with the Paris system of implant rules.

RESULTS

Patient tolerated the treatment well and had grade three mucositis patch replacing the lesion at 3 weeks post treatment. At 3 months, she had a complete response with no xerostomia and minimal hyperpigmentation of overlying skin at catheter entry points. She is currently on follow-up at 1 year with no clinical or radiological evidence of disease.

CONCLUSIONS

Radical Brachytherapy offers excellent outcomes in early buccal mucosal lesions. Customized templates may be created using 3D printing to perform ISBT in Head and Neck Cancers in technically difficult cases.