ABSTRACT Early stage cancers of tongue are treated traditionally with a wide local excision or hemiglossectomy, but the preservation of normal speech and swallowing are hampered. Most of the patients are treated with external beam irradiation to achieve the best locoregional control as only a limited number of tongue cancers can be excised. Underdeveloped nations with finite resources are still dependent on cobalt based external beam radiotherapy and sometimes a Linear Accelerator with two dimensional planning. This treatment has many limitations, as the large radiation fields irradiate not only the tumor but also normal tissue. The sequalae include mucositis, dry mouth, teeth and gum injury, spinal cord damage and rarely mandibular necrosis. Intensity modulated radiotherapy, which can abrogate these side effects, is not available to these patients. Irradiation using implanted solid radioactive sources into the tumor tissue is a viable option in this context. This kind of treatment is termed as brachytherapy and if the implant is introduced into the tissue then it is interstitial brachytherapy. This report details our experience in interstitial implantation, planning, dosimetry and treatment. Diagnosed cancers of anterior 2/3rd of lateral border of tongue with T1 N0M0 or T2 N0M0 stages were subjected to Iridium implantation under general anesthesia. Orthogonal films were taken and planning done with brachyvision treatment planning system. High dose rate radiotherapy was delivered as per the prescription. Excellent local control of the tumor was achieved with no undue morbidity to the adjacent structures. The patients were asked to undergo regular follow up. Surgical salvage was advised in cases of nodal recurrence. Interstitial implantation is a treatment that can be safely administered in early stage cancers of the tongue. This has remarkable efficacy and is also a patient friendly procedure.
Cite this paper
V. Narayanan, B. Acharya, C. Prasad and D. Gautam, "Iridium Implantation in T1 and T2 Cancers of Anterior Tongue: Report from B. P. Koirala Memorial Cancer Hospital, Nepal," International Journal of Medical Physics, Clinical Engineering and Radiation Oncology, Vol. 1 No. 3, 2012, pp. 73-77. doi: 10.4236/ijmpcero.2012.13010.
 M. T. Gillin, et al., “Practical Considerations for Interstitial Brachytherapy,” University of Wisconsin, Madison, 1988.
 S. A. Leibel, T. I. Phillips, et al., “Text Book of Radiation Oncology,” WB Saunders, Philadelphia, 1998.
 J. R. Williams and D. I. Thwarts, “Radiotherapy in Practice,” Oxford University Press, 1993.
 D. K. Baskota, R. Agrawal, et al. “Distribution of Malignancies in Head and Neck Regions and Their Manage- ment,” Journal of the Nepal Medical Association, Vol. 44, No. 159, 2005, pp. 68-72.
 S. W. Beenken, H. Krontiras, W. A. Maddox, G. E. Peters, S. Soong and M. M. Urist, “T1 and T2 Squamous Cell Carcinoma of the Oral Tongue: Prognostic Factors and the Role of Elective Lymph Node Dissection,” Head & Neck, Vol. 21, No. 2, 1999, pp. 124-130.
 D. G. Sessions, G. J. Spector, J. Lenox, B. Haughey, C. Chao and J. Marks, “Analysis of Treatment Results for Oral Tongue Cancer,” Laryngoscope, Vol. 112, No. 4, 2002, pp. 616-625. doi:10.1097/00005537-200204000-00005
 M. A. Gonzalez-Moles, F. Esteban, A. Rodriguez-Ar- chilla, et al, “Importance of Tumour Thickness Measurement in Prognosis of Tongue Cancer,” Oral Oncology, Vol. 38, No. 4, 2002, pp. 394-397.
 T. M. P. Amaral, A. R. Da Silva Freire, et al., “Predictive Factors of Occult Metastasis and Prognosis of Clinical Stages I and II Squamous Cell Carcinoma of the Tongue and Floor of the Mouth,” Oral Oncology, Vol. 40, No. 8, 2004, pp. 780-786.
 J. J. Grau, J. Domingo, J. L. Blanch, E. Verger, et al., “Multidisciplinary Approach in Advanced Cancer of the Oral Cavity: Outcome with Neoadjuvant Chemotherapy According to Intention-to-Treat Local Therapy. A Phase II Study,” Oncology, Vol. 63, No. 4, 2002, pp. 338-345.
 R. W. Hinerman, W. M. Mendenhall, C. G. Morris, et al., “Postoperative Irradiation for Squamous Cell Carcinoma of the Oral Cavity: 35-Year Experience,” Head & Neck, Vol. 26, No. 11, 2004, pp. 984-994.
 N. Lee, D. R. Puri, A. I. Blanco and K. S. Chao, “Intensity-Modulated Radiation Therapy in Head and Neck Cancers: An Update,” Head & Neck, Vol. 29, No. 4, 2007, pp. 387-400. doi:10.1002/hed.20332
 D. R. Puri, W. Chou and N. Lee, “Intensity-Modulated Radiation Therapy in Head and Neck Cancers: Dosimet- ric Advantages and Update of Clinical Results,” Ameri- can Journal of Clinical Oncology, Vol. 28, No. 4, 2005, pp. 415-423. doi:10.1097/01.coc.0000162443.08446.00
 F. F. de Arruda, D. R. Puri, J. Zhung, A. Narayana, et al., “Intensity-Modulated Radiation Therapy for the Treatment of Oropharyngeal Carcinoma: The Memorial Sloan-Kettering Cancer Center Experience,” International Journal of Radiation Oncology *Biology* Physics, Vol. 64, No. 2, 2006, pp. 363-373. doi:10.1016/j.ijrobp.2005.03.006
 K. S. Chao, G. Ozyigit, A. I. Blanco, W. L. Thorstad, et al., “Intensity-Modulated Radiation Therapy for Oropharyngeal Carcinoma: Impact of Tumor Volume,” International Journal of Radiation Oncology *Biology* Physics, Vol. 59, No. 1, 2004, pp. 43-50.
 J. J. Mazzeron, J. M. Crook, V. Benck, et al., “Iridium Implantation of T1 & T2 Carcinoma of Mobile Tongue,” International Journal of Radiation Oncology *Biology* Physics, Vol. 19, No. 6, 1990, pp. 1369-1376.
 D. Dearnaley, C. Dardaufas, et al., “Interstitial Irradiation for Carcinoma of Tongue and Floor of Mouth: Royal Marsden Hospital Experience 1970-1986,” Radiotherapy & Oncology, Vol. 21, 1991, pp. 183-190.
 D. Sloan and H. Goepfert, “Conventional Therapy for Head and Neck Cancer,” Hematology/Oncology Clinics of North America, Vol. 5, No. 4, 1991, pp. 601-625.
 M. Umeda, H. Komatsubara, N. Nishimatsu, et al., “High Dose Rate Interstitial Brachytherapy for Stage I-II Tongue Cancer,” Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and Endodontology, Vol. 90, No. 5, 2000, pp. 667-670. doi:10.1067/moe.2000.110087