Case report Successful interstitial treatment for bilateral tongue cancer

Abstract. We report three cases of bilateral tongue cancer who received interstitial brachytherapysuccessively for each tumour. Tumour control following treatment are as good as that forunilateral tongue cancer and there have been no severe complications in, or around, the tumourarea after using a mandibular protective spacer and dose reduction for the second treatment.Bilateral tongue cancers, which are synchro-nous multicentric cancers found on both sides ofthe oral tongue, are rare. In the last 5 years wehave experienced three such cases and report theresults of treatment by low dose rate brachythera-py for each cancer. Case reports Case 1 A 36-year-old male complained of pain on theright side of his tongue in 1985. He was diagnosedas having leukoplakia pathologically and followedup. In 1991, he noticed another painful lesion onthe left side of his tongue. In 1993, biopsies weretaken from both sides of the tongue whichconfirmed the diagnosis of bilateral squamouscell carcinomas. As the patient was an actor, hewas referred to our institution to receive tongueconserving treatment.On examination the right-sided tumour wassuperficial type measuring 3.661.4 cm, whereasthe left-sided cancer was nodular type measuring1.661.460.3 cm. Cervical lymph node metas-tases were not detected.Because it was associated with pain, the right-sided tumour was treated first by interstitialbrachytherapy with radium-226 needles implantedin a single plane (treated area 4.563.5 cm); thepatient was given 70 Gy in 154 h (Figure 1aand 2). After 7 days, the left-sided lesion wastreated with iridium-192 hairpins implanted in asingle plane (treated area 364 cm); 60 Gy wasgiven in 116 h (Figure 1b and 2). Using the spacerduring interstitial brachytherapy for both lesions,there were no severe complications during, orafter, treatment.In 1996 the patient was suspected of havingrecurrent tumour on the right side of his tongue.A biopsy confirmed the diagnosis of squamouscell carcinoma. He proceeded to hemiglossectomyand prophylactic neck dissection.Since then, he has had neither recurrence of theprimaries nor lymph node metastasis.