Kwong D L, Wei W I, Cheng A C, Choy D T, Lo A T, Wu P M, Sham J S
Department of Clinical Oncology, University of Hong Kong, Queen Mary Hospital, Hong Kong.
Cancer. 2001 Mar 15;91(6):1105-13.
Brachytherapy is useful for the reirradiation of nasopharyngeal carcinoma. In the current study, the long term treatment results of permanent radioactive gold(198) grain interstitial implantation in patients with persistent and recurrent nasopharyngeal carcinoma were reviewed.
Gold grain implantation was performed under direct vision with a split palate approach to provide 60 grays (Gy) 0.5 cm away from the plane of implantation. Between August 1986 and May 1999, 106 patients were treated with gold grain implantation (45 patients for persistent disease, 53 patients for first recurrence, and 8 patients for second recurrence in the nasopharynx). All patients had histologically proven disease by biopsy before undergoing implantation.
Patients with persistent disease and those with first recurrence did well with the gold grain implantation. The 5-year local control rates for patients with persistent disease, first recurrence, and second recurrence in the nasopharynx were 87.2%, 62.7%, and 23.4%, respectively (P = 0.0004). The 5-year metastasis free survival rates were 68.1%, 60.3%, and 40%, respectively, for the 3 groups (P = 0.048). The overall survival rates at 5 years for the 3 groups were 79.1%, 53.6%, and 42.9%, respectively (P = 0.0047). Patients with computed tomography evidence of disease extension outside the nasopharynx had a lower local control rate compared with patients whose disease was confined to the nasopharynx (5-year local control rate of 52% vs. 72.3%; P = 0.031). The size of the lesion was not found to be an independent prognostic factor for local control after implantation. Multivariate analysis showed only an indication for implantation (persistent disease, first recurrence, and second recurrence) to be a significant prognostic factor for local control. Complications attributed to gold grain implantation included headache, palatal fistula, and mucosal radiation necrosis at the site of implantation, and were reported to occur in 28.3%, 18.9%, and 16%, respectively, of patients.
For selected patients with disease confined to the nasopharynx, gold grain implantation is an effective salvage treatment for persistent and recurrent nasopharyngeal carcinoma.
近距离放射治疗对鼻咽癌再程放疗有用。在本研究中，回顾了永久性放射性金（198）粒间质植入治疗持续性和复发性鼻咽癌患者的长期治疗结果。
采用腭裂劈开直视下进行金粒植入，在距植入平面0.5厘米处给予60戈瑞（Gy）剂量。1986年8月至1999年5月，106例患者接受了金粒植入治疗（45例为持续性疾病患者，53例为首次复发患者，8例为鼻咽部第二次复发患者）。所有患者在植入前经活检组织学确诊。
持续性疾病患者和首次复发患者金粒植入效果良好。持续性疾病、首次复发和鼻咽部第二次复发患者的5年局部控制率分别为87.2%、62.7%和23.4%（P = 0.0004）。三组患者的5年无转移生存率分别为68.1%、60.3%和40%（P = 0.048）。三组患者的5年总生存率分别为79.1%、53.6%和42.9%（P = 0.0047）。计算机断层扫描显示疾病扩展至鼻咽部以外的患者与疾病局限于鼻咽部的患者相比，局部控制率较低（5年局部控制率分别为52%和72.3%；P = 0.031）。未发现病变大小是植入后局部控制的独立预后因素。多因素分析显示，仅植入指征（持续性疾病、首次复发和第二次复发）是局部控制的重要预后因素。金粒植入引起的并发症包括头痛、腭瘘和植入部位的黏膜放射性坏死，分别有28.3%、18.9%和16%的患者报告出现这些并发症。
对于疾病局限于鼻咽部的特定患者，金粒植入是持续性和复发性鼻咽癌的有效挽救治疗方法。
