Nag S, Schuller D E, Rodríguez-Villalba S, Martínez-Monge R, Grecula J
Division of Radiation Oncology, Ohio State University, Columbus, OH 43210, USA.
Rev Med Univ Navarra. 1999 Apr-Jun;43(2):56-61.
To develop a novel technique, intraoperative high-dose rate brachytherapy (IOHDR), in the treatment of previously irradiated head and neck cancers located at anatomical sites inaccessible to intraoperative electron beam radiotherapy (IOERT).
Between October 1992 and June 1997, seven patients (median age = 65 yrs; range = 52 to 71 years) with previously irradiated head and neck recurrences at anatomical sites inaccessible to IOERT in the base of skull were treated with IOHDR after maximal resection for microscopic residual disease. Treatment volume ranged from 6 cc to 24 cc. Six patients received 15 Gy of IOHDR at 0.5 cm; one received 10 Gy using custom-made surface foam applicators.
The median follow-up was 59 months (range 33 to 67 months). It was technically feasible to deliver IOHDR in all seven patients at sites that were inaccessible to IOERT. The morbidity (observed in two patients) was acceptable and generally surgically related. Four of seven patients (57%) were locally controlled at IOHDR site. Two failed regionally, outside the IOHDR treated sites. The disease-free survival ranged from 3 to 30 months (median 9 months) with two patients still alive, disease-free at 28 and 30 months.
IOHDR can be used, with limited toxicity, to treat previously irradiated head and neck cancers at sites inaccessible to IOERT. We are currently evaluating the addition of limited EBRT dose to improve the local control of these poor prognosis recurrent tumors.
开发一种新技术，即术中高剂量率近距离放射治疗（IOHDR），用于治疗先前接受过放疗的头颈部癌，这些癌症位于术中电子束放疗（IOERT）无法到达的解剖部位。
1992年10月至1997年6月，7例（中位年龄 = 65岁；范围 = 52至71岁）先前接受过头颈部放疗且在颅底IOERT无法到达的解剖部位复发的患者，在进行最大程度切除以清除微小残留病灶后，接受了IOHDR治疗。治疗体积为6立方厘米至24立方厘米。6例患者在0.5厘米处接受了15 Gy的IOHDR；1例使用定制的表面泡沫施源器接受了10 Gy。
中位随访时间为59个月（范围33至67个月）。在所有7例患者中，在IOERT无法到达的部位进行IOHDR在技术上是可行的。发病率（在2例患者中观察到）是可接受的，且一般与手术相关。7例患者中有4例（57%）在IOHDR部位得到局部控制。2例在IOHDR治疗部位以外区域复发。无病生存期为3至30个月（中位9个月），2例患者仍存活，分别在28个月和30个月时无病。
IOHDR可用于治疗先前接受过放疗且位于IOERT无法到达部位的头颈部癌，毒性有限。我们目前正在评估增加有限剂量的外照射放疗（EBRT）以改善这些预后不良的复发性肿瘤的局部控制情况。
