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Advanced Radiotherapy and Brachytherapy Techniques in Head and Neck Cancer Management

Comprehensive overview of radiotherapy, brachytherapy, imaging, and treatment planning for head and neck cancers, emphasizing tumor control, tissue sparing, and quality of life improvements.

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Dr. Kanhu Charan Patro Clinical Director and HOD (Radiation Oncology) (Brain Tumor Specialist) Mahatma Gandhi Cancer Hospital & RI, Visakhapatnam MBBS (Gold Medalist) MD, DNB (Radiation Oncology) MBA (HA), FICRO, FAROI [USA], CEPC, PDCR Visiting Fellow Manheim Cancer Center, Germany Visiting trainee in Accuray Genolier, Switzerland Visiting Fellow Well Cornell Medical College, New York Ex. Resident (TMH-Mumbai) Visiting trainee (AIIMS-New Delhi) drkcpatro@gmail.com / M-9160470564/drkanhupatro.com SL SUBJECT INFERENCE 1 Area of interest NEURO AND URO-ONCOLOGY, NON - INVASIVE BRACHYTHERAPY 2 Clinical experience 25+ years 3 Cancer patients handled (RADIOTHERAPY) Nearly 10000 4 Brain tumors handled Nearly 1000 5 Brachytherapy cases handled Nearly 4000 6 Interstitial brachytherapy cases handled Nearly 600 7 SRS/SBRT cases handled Nearly 200 8 Article publication Nearly 50 9 Slide share presentations Nearly 300 10 E Books/Chapter/Abstract Nearly 120 11 Awards received 12 12 Faculty invite- conferences More than 100 13 Thesis guided 10 14 Academic teacher experience 8 years 15 Fellowships awarded 4
• Onco-Surgeons • Radiation Oncologists • Medical Oncologists • Dental Surgeons • Plastic surgeons • Oncology Nurses • Occupational therapist • Speech & Swallowing therapist • Psychologist
• Lip • Buccal mucosa • Gingiva • Mandible • Orla tongue • Hard palate • Floor of mouth • RMT
• Clinical examination • Upper GI Endoscopy • MRI/CT • BIOPSY • IHC
• Examination
Imaging 08/13/2026 Mahatma Gandhi Cancer Hospital & Research Institute,Visakhapatnanm 14
17 RADIOLOGY OF FLOOR OF MOUTH
30 RADIOLOGY OF CANCER BUCCAL MUCOSA
(A) Bucco masseteric region bounded by zygomaticus major (arrowhead), masseter(m), buccinator (+) inserting into pterygomandibular raphe (*) and terminal parotid duct(arrow). (B) Shows orbicularis oris (arrowhead) and levator anguli oris (arrow)
Puffed check coronal 1. Showing oral cavity proper with tongue (asterisk), 2. Vestibule (short arrow), 3. Lower gingivobuccal sulcus (long arrow), 4. Hard palate(^) 5. Buccal mucosa closely apposed to buccinator (+)
A) Axial CECT showing the Puffed Cheek technique in B) That separates the buccal and gingival surfaces with air depicting that epicenter of lesion (arrows) is in the buccal mucosa . C) The lesion does not abut mandible as appears in A
Lower GBS involvement
RMT- Retromolar trigone
The retromolar trigone RMT
Spread of RM cancers, 1. Buccal mucosa (yellow arrow), maxillary and mandibular alveolus (red arrow) 2. Base tongue/FOM (white arrow), tonsil (orange arrow), 3. Masticator space (black arrow), and through pterygomandibularraphe (*) 4. Superiorly to pterygopalatine fossa
1. (A) Squamous cancer in the upper GBS eroding floor of left maxillary sinus(arrow) and laterally invading skin (*). 2. (B) Advanced buccal SCC with lateral spread to skin and orocutaneous fistulation(arrow). Posteriorly adherent to masseter (m)
(A) Coronal CT reformat showing squamous carcinoma with high masticator space invasion (*), (+) shows normal opposite lateral pterygoid. (B) Bone window. Arrows in A and B show widened foramen ovale with enhancement in A (perineural spread)
1. (A) showing extension along pterygomandibular raphe to tonsil (T) 2. (B) Oblique reformat showing mandibular invasion (arrow) 3. (C) Mandibular erosion and tongue invasion (arrow) 4. (D) Superior spread to pterygopalatine fossa (arrow) seen as loss of normal fat density
A. Shows squamous carcinoma in posterior right buccal mucosa (yellow line) reaching RMT (arrow), invading masseter(m). B. Arrow shows left medial pterygoid invasion and erosion of vertical mandibular ramus
Left buccal mucosa
Lt buccal mucosa with RMT
Mucoepidermoid of buccal mucosa
With skin infiltration and ulcerartion
Left lower alveolus
Hard palate
Soft palate- soft tissue window
Hard palate- bone window
Options • Surgery alone • T1/T2 NO • Radiotherapy alone • T1/T2 NO • EBRT alone • Brachy alone • Surgery + radiotherapy • LVI+ • PNI+ • NODE+ • T3 • Surgery + Radiotherapy + Chemotherapy • ECE+ • MARGIN+ • ADVANCED • Radiotherapy + Chemotherapy • Inoperable
Adjuvant RT if depth>4mm
Role of radiotherapy in various cancers 08/13/2026 01:42:10 AM 72 Needed for all most head and neck cancer Radical • Nasopharynx, larynx, hypopharynx etc. Post-op-adjuvant • Mostly All Oral Cancers except T1 lesions Palliative • Compression, Bleeding, Obstruction, Pain
Postoperative Radiation for Oral Cavity Squamous Cell Carcinoma • Oral Cavity Cancer is a Surgical Disease • Use Radiation Postoperatively for Appropriate Patients
Site Size Type Depth LVI PNI 6 margins Risk scoring Nodes dissected Positive nodes Extra nodal extension
Radiation Alone for Early-Stage Oral Cavity Cancer RT can be used as primary therapy for small (T1, T2) tumors of the oral cavity. Oral tongue Floor of Mouth Lip Best results are with a combination of external beam radiation and brachytherapy
The dental surgeon’s role
08/13/2026 01:42:12 AM 90 Wilhelm Conrad Rontgen
History- radiation 1896 – Becquerel - Radioactivity 1898 – Madam Curie / Pierre Curie - Radium 1903 – Nobel Prize for Curie’s & Becquerel 1903 – First successful case of malignancy basal cell carcinoma of face 08/13/2026 01:42:12 AM 91
GOALS  High dose to tumor tissue-Tumor control  Normal tissue sparing  Minimize long and short term toxicities  Better Quality of life 08/13/2026 01:42:12 AM 92
Treatment • Delivered 5 days per week over 6-8 weeks • Typical treatment takes around 5 minutes • Treatment is painless--like having an X-ray taken • No radioactive substances involved; beam goes on/off • Side effects usually temporary; controlled with medication/diet • Covered by Medicare and many other insurance companies 08/13/2026 01:42:12 AM 93
Types of radiotherapy 08/13/2026 01:42:12 AM 94 TELETHERAPY BRACHYTHERAPY
Radiotherapy procedure 1. Tumor board decision 2. Positioning And immobilization 3. Imaging 4. Target delineation 5. Planning 08/13/2026 Mahatma Gandhi Cancer Hospital & Research Institute,Visakhapatnanm 95
IMAGE GUIDED RADIATION THERAPY EQUIPMENT REQUIRED CT-SCAN MRI PET-CT 08/13/2026 96 Mahatma Gandhi Cancer Hospital & Research Institute,Visakhapatnanm
Cobalt machine 08/13/2026 01:42:13 AM 97
08/13/2026 01:42:13 AM 98
Plaster of Paris Mould-older method 08/13/2026 01:42:13 AM 99
Head & Neck 08/13/2026 01:42:13 AM 100