Reirradiation with brachytherapy for recurrent tongue cancer after initial brachytherapy

The purpose of this study was to assess the efficacy of reirradiation with brachytherapy in the treatment of patients with tongue cancer that had recurred after initial brachytherapy. A retrospective analysis was performed in 12 patients with tongue cancer treated by reirradiation with brachytherapy using rigid linear sources such as the 226Ra-needle or 192Ir-hairpin at Kyushu University Hospital from 1978 to 1998. The patients included 8 men and 4 women, who ranged in age from 30 to 69 years (mean, 52 years). At the time of reirradiation, 7 patients had stage I cancer, and 5 had stage II cancer, according to the UICC (1997) classification. The median follow-up time of the surviving patients was 92 months. The 5-year relapse-free and cause-specific survival rates were 31% and 64%, respectively. The 5-year cause-specific survival rate varied according to the interval between the first and second course of brachytherapy and was 25% for intervals of less than 12 months and 83% for intervals of more than 12 months. Only 4 patients with local recurrence were recognized after their second course of brachytherapy. Among the 6 patients who survived more than 2 years after reirradiation without local recurrence, symptomatic complications such as soft tissue necrosis and minimal bone necrosis were found in 3 patients, but these side effects were not serious enough to require surgery. Reirradiation with a second course of brachytherapy may be useful in the treatment of patients with tongue cancer that recurs more than 12 months after initial brachytherapy.