High dose rate brachytherapy in the treatment of oral cancer--the preliminary one institution experience.

Low dose rate brachytherapy is well established treatment modality of oral cancer. Data about high dose rate brachytherapy (HDR BT) are still scarce with heterogenous results. The aim of our study was to evaluate preliminary results in a small group of oral cancer patients treated by HDR BT. Seventeen applications were performed on 16 patients in years 2001-2004, in 15 cases for new tumor (mobile tongue 10x, floor of mouth 2x, lip 3x) and in 2 cases for local recurrence after radiotherapy. Ten treatments (for T1-2N0 tumors and recurrences) were performed with brachytherapy alone (18 x 3 Gy twice daily), seven patients (T2-3 N0-2 tumors) were treated with a combination of external beam radiotherapy (40-68 Gy) and brachytherapy (2-6 x 3 Gy twice daily). The plastic tubes technique was used for brachytherapy. Follow-up periods were between 8-46 months (median 17). Fifteen patients were disease free during follow-up period. One patient (brachytherapy alone for T2N0M0 mobile tongue cancer) died immediately after neck dissection for the neck recurrence due to the heart failure. The other one died due to distant metastases but without local recurrence. Acute complications were mucositis gr. II at maximum, late complications were ulcer of soft tissues in 3 and superficial bone necrosis in 2 cases. The evaluation of the brachytherapy implants was done according ICRU 58 recommendations. Hyperfractionated high dose rate brachytherapy alone or as a boost to external beam radiotherapy is feasible with promising local control. Carefull planning of the implant and mandibular shielding are necessary to avoid complications.

Giant cell epulis with unusual clinical and radiological features--a diagnostic pitfall in FNAC material. Report of a case with differential diagnosis.

Giant cell epulis (peripheral giant cell granuloma) is a tumorlike condition of the gingiva found predominantly in elderly women. A case of peripheral giant cell granuloma of the mandibular gingiva, examined by fine needle aspiration biopsy, is herein reported. A 51-year-old woman presented with a three week history of bleeding from a six cm tumor located in the central part of the mandible. On radiography, an osteolytic lesion was present, suspicious of malignancy. An aspiration biopsy revealed microscopic features suggesting the diagnosis of a giant cell lesion of possibly malignant nature. Surgical resection was performed. Histological examination showed giant cell epulis destroying the mandibular bone. Differential diagnosis of this lesion is widely discussed.

Longterm catheterization of the lingual artery for intraarterial cytostatic therapy.

The authors present a technique of longterm lingual artery catheterization for intraarterial regional chemotherapy. The transtemporal approach enables safe introduction through the external carotid artery. Catheterization technique is presented in 16 patients with the diagnosis of carcinoma baseos oris and carcinoma linguae. Both the lingual arteries were infused in four patients with tumors spreading over the midline. The dislocation of the catheter was found seven times of twenty catheterizations. The following catheter repozition was always successful.

[The importance interdisciplinary cooperation in the prevention of radiation osteomyelitis of the jaws]. / Význam interdisciplinární spolupráce pro prevenci radioosteomyelitidy celistí.

A case-history of radioosteomyelitis of the mandible, treated at the department of maxillofacial surgery which developed in a patient irradiated on account of carcinoma of the base of the mouth. Before therapy the appropriate preventive provisions were not made. The authors emphasize that before irradiation of malignant tumours of the oral cavity and pharynx a stomatologist should be consulted. Radioosteomyelitis may be, after in other respects successful antitumourous treatment, equally dangerous for the patient as the basic neoplastic disease.