*Radiotherapy in Oral Cancers: Current Perspective and Future Directions DOI: http://dx.doi.org/10.5772/intechopen.99557*

allow for acceptable dose and fractionation schedules, image guidance, dose optimization and better radiation protection mechanisms.

Common cancer sites where brachytherapy can be used in oral cavity are mobile tongue, lip, buccal mucosa, floor of mouth and palate [52, 53]. Indications for use of brachytherapy presently is


Disadvantages for brachytherapy are primarily due to lack of expertise and need for an initial learning curve which is usually lacking other than in bigger institutes, ease of modern conformal external radiotherapy techniques, competition with modern surgical techniques and concerns of radiation protection. Some relative contraindications to this procedure in oral cavity tumours would be compromised mouth opening, difficult naso-tracheal intubation & those having large defects requiring flap reconstructions in post-op setting.

Usually, the procedure followed is a single implant with multiple treatment fractions over nearly a week. Procedure is done under general anaesthesia with the help of nasotracheal intubation and dental separators to allow for proper visualisation. An interstitial implant is done following the principles of the Paris technique (**Figures 7** and **8).** A CT-scan based planning is done and the oncologist will delineate the tumour and organs at risk on the treatment planning system. Doses delivered are between 3-4Gy in 10–12 fractions delivered six hours apart over

**Figure 7.** *Brachytherapy of tongue.*

**Figure 8.** *Brachytherapy of buccal mucosa.*

5–6 days in the primary treatment setting and 3-4Gy in 6–8 fractions over 3–4 days in the boost setting.

Acute complications of brachytherapy could be haemorrhage, infection, airway compromise & sialadenitis. Long term side effects could be soft tissue necrosis, telangiectasia and rarely osteoradionecrosis.
