None of the patients stopped treatment during the course of brachytherapy. After brachytherapy, the patients were followed up for 24–218 months. Their median survival time and average overall survival time were 36 months and 48 months, respectively. The acute complications associated with brachytherapy (mucositis, taste and sensory disorders, etc.) were not severe enough to interfere with oral intake, and no patients required tube feeding. All of the early complications had resolved and the patients had recovered to their pre-cancer condition within 3 months after the start of brachytherapy.
Their median disease-specific survival (DSS) time was 50 months. The 3-year and 5-year primary control rates were both 86% (). The overall 3-year and 5-year survival rates were 57% and 49%, respectively ().
Local control in the cases as a whole.
Overall survival in the cases as a whole.
The 3-year and 5-year DSS rates were 74% and 68%, respectively. The statistical difference was calculated by the Kaplan–Meier method. The 5-year DSS rates for Stage I and Stage II were 51% and 72%, respectively, and were not significant (p<0.05) (). The 7-year DSS rates for patients aged under 80 years old and over 80 years old were 70% and 41%, respectively, and the difference was significant (p = 0.03) ().
Overall disease-specific survival (DSS) in the cases as a whole.
Cause-specific survivals of patients with tongue cancer at Stage II. ys, years.
There were 20 recurrences at the site of primary lesion between 1 and 81 months (median: 8 months) after brachytherapy. There were 47 neck lymph node metastases from 1 to 57 months (median: 6 months) following brachytherapy. Partial tongue resection was performed to treat 7 out of 20 primary site recurrences, which was successful in 4 of them. Two other local recurrences were treated by additional 198Au grain implantation, and one of the two cases was successful. No treatment was indicated in 11 cases of local recurrence, and all 11 patients died of the disease. Final local control at 5 years was: T1 = 90% and T2 = 85%. Radical neck dissection was performed to treat 24 cases of neck node metastasis: 21 patients were under 80 years old and 3 patients were over 80 years old. Another 19 cases of neck node metastasis were treated by radiation and no treatment was indicated for the remaining 4 cases of neck node metastasis. Radical neck dissection was successful in 15 (62%) out of the 24 cases, but radiation therapy with over 60 Gy in 6 weeks was successful in only 4 of the 19 cases (21%).
There were two cases of post-treatment radiation ulcer-and one case of bone exposure prior to introduction of spacers, but all three patients recovered within 1 year in response to conservative treatment. No bone and/or soft-tissue complications that interfered with the patients’ post-treatment life occurred after introduction of the spacers. In 22 patients, 23 post-treatment multiple cancers were diagnosed: 7 head and neck cancers, 5 lung primary cancers, 2 cancers each of the oesophagus, pancreas, kidney and haematological system and 1 cancer each of the bladder, stomach and small intestine.