Intraoral Cone Radiotherapy for Cancer of the Oral Cavity

Objective: To evaluate treatment results of intraoral cone therapy with or without external radiotherapy as primary treatment in patients with carcinoma of oral cavity. Methods: Between the years 1997 and 2011, 14 patients were identified for retrospective review. Statistical analysis by the Kaplan Meier method was performed for local disease–free survival, disease-free survival, and overall survival. Results: The median patient age was 68 (range, 45-83) years; they all had squamous cell carcinoma and 12 (86%) were male. The tongue was the commonest primary site (n = 9). In all, nine (64%) has significant comorbidities; five (36%) were not fit for surgery, four (29%) refused surgery, and five (36%) aimed for organ preservation. Eleven (79%) were T1 or T2, three (21%) were T3 or T4. Two (14%) patients received intraoral cone therapy alone, and 12 (86%) both intraoral cone and external radiotherapy. Two (14%) received concurrent chemotherapy and radiotherapy. The most commonly used regimen was 3 Gy/fr for 7 to 8 fractions (ranging from 2-3 Gy/fr for 3-19 fractions). The dose of locoregional external radiotherapy ranged from 50 to 66 Gy (median, 50 Gy). The median follow-up time was 55 (range, 2-157) months. The 2-year and 5-year disease-free survival were 91% and 80%, and 2-year and 5-year overall survival were 71% and 54%, respectively. Three patients (21%) developed local recurrence and all have salvage surgery done. Five-year local control rate was 83%. Three patients (21%) developed grade-3/4 mucositis, one patient (7%) developed radionecrosis, one patient (7%) developed sarcoma. Conclusion: Intraoral cone radiotherapy is an effective means for treating primary tumours in the oral cavity with organ preservation. It is a feasible therapeutic option if the patient refuses, is too old, or not fit for surgery or brachytherapy.