Harms W, Schraube P, Becker H, Latz D, Herth F, Fritz P, Wannenmacher M
Department of Radiology, Radiation Therapy, University of Heidelberg, Germany.
Strahlenther Onkol. 2000 Feb;176(2):60-6. doi: 10.1007/pl00002329.
To assess effect and toxicity of high-dose-rate afterloading (HDR) alone or in combination with external beam radiotherapy (EBRT) in centrally located tumors of the upper respiratory tract.
From 1987 to 1996, 55 patients were treated. Twenty-one patients (group A1: 17 non-small-cell lung cancer [NSCLC], A2: 4 metastases from other malignancies) were treated using HDR alone due to a relapse after external beam irradiation. In 34 previously untreated and inoperable patients (group B1: 27 NSCLC, B2: 7 metastases from other malignancies) HDR was given as a boost after EBRT (30 to 60 Gy, median 50). HDR was carried out with a 192Ir source (370 GBq). The brachytherapy dose (group A: 5 to 27 Gy, median 20; B: 10 to 20 Gy, median 15) was prescribed to 1 cm distance from the source axis. A distanciable applicator was used in 39/55 patients.
In group A1, a response rate (CR, PR) of 53% (group B1: 77%) was reached. The median survival (Kaplan-Meier) was 5 months in group A1 (B1: 20 months). The 1-, 3- and 5-year local progression free survival rates (Kaplan-Meier) were 66% (15%), 52% (0%), and 37% (0%) in group B1 (group A1). Prognostic favorable factors in group B1 were a tumor diameter < 20 mm, the lack of radiological mediastinal involvement, a complete remission, and a Karnofsky performance status > 70. Grade-1 or 2 toxicity (RTOG/EORTC) occurred in 0% in group A and in 6% in group B. We observed no Grade-3 or 4 toxicity. Complications caused by persistent or progressive local disease occurred in 3 patients in group A (fatal hemorrhage, tracheomediastinal fistula, hemoptysis) and in 2 patients in group B (fatal hemorrhage, hemoptysis).
HDR brachytherapy is an effective treatment with moderate side effects. In combination with external beam irradiation long-term remissions can be reached in one third of the patients.
评估高剂量率后装治疗（HDR）单独应用或联合外照射放疗（EBRT）治疗上呼吸道中央型肿瘤的疗效及毒性。
1987年至1996年，共治疗55例患者。21例患者（A1组：17例非小细胞肺癌[NSCLC]，A2组：4例其他恶性肿瘤转移灶）因外照射后复发，仅接受HDR治疗。34例既往未治疗且无法手术的患者（B1组：27例NSCLC，B2组：7例其他恶性肿瘤转移灶）在EBRT（30至60 Gy，中位剂量50 Gy）后给予HDR作为追加剂量。采用192Ir源（370 GBq）进行HDR治疗。近距离放疗剂量（A组：5至27 Gy，中位剂量20 Gy；B组：10至20 Gy，中位剂量15 Gy）规定为距源轴1 cm处的剂量。55例患者中有39例使用了可分离式施源器。
A1组的缓解率（CR，PR）为53%（B1组：77%）。A1组的中位生存期（Kaplan-Meier法）为5个月（B1组：20个月）。B1组（A1组）的1年、3年和5年局部无进展生存率（Kaplan-Meier法）分别为66%（15%）、52%（0%）和37%（0%）。B1组的预后有利因素为肿瘤直径<20 mm、无放射学纵隔受累、完全缓解以及卡氏评分>70。A组0%的患者出现1级或2级毒性反应（RTOG/EORTC标准），B组为6%。未观察到3级或4级毒性反应。A组有3例患者（致命性出血、气管纵隔瘘、咯血）以及B组有2例患者（致命性出血、咯血）出现由持续性或进行性局部病变引起的并发症。
HDR近距离放疗是一种有效的治疗方法，副作用较轻。联合外照射放疗，三分之一的患者可实现长期缓解。
