Magné N, Porsin B, Marcy P-Y, Benezery K, Poudenx M, Vallino P, Otto J, Marcié S, Lagrange J-L
Département de radiothérapie, centre Antoine-Lacassagne, 33, avenue de Valombrose, 06189 cedex 2, Nice, France.
Cancer Radiother. 2003 Jun;7(3):160-5. doi: 10.1016/s1278-3218(03)00026-x.
Intra-operative intertitial brachytherapy has been applied in the curative and palliative treatment of lung cancer. Implantation of radio-active sources offers an advantage over external irradiation because of the limited penetrability from source to prescription point, resulting in rapid dose fall-off and sparing of surrounding normal tissues. The aim of this study was to re-evaluate retrospectively the Antoine-Lacassagne cancer center experience in endobronchial brachytherapy by low dose rate (LDR) or high dose rate (HDR) and to design perspectives for the next decades. Evaluation was based on analysis of toxicities, response rates and survival.
From october 1989 to june 1999, 31 consecutive patients with bronchogenic carcinoma were treated. Thirteen and 18 patients received LDR and HDR, respectively. The mean age was 65 years (range 44 to 79 years). Inclusion criteria were, for palliative treatment, incurable endobronchial cancer, and for curative treatment, residual tumor in the margins after resection, or endobronchial tumor could not be treated surgically. Exclusion criteria were sites of lesion unsuitable for placement of the brachytherapy catheter. Evaluation of complications and clinical response were based on endoscopic evaluation one month after the last session and at less one year after the end of treatment.
Eighty-seven courses have been performed: 65 by LDR and 22 by HDR. Thirty-six courses have been performed in the palliative group, 51 courses in the curative group. Seven patients among 31 presented acute complications and 18/31 late complications. Complete global response rate was 14/30 evaluable patients (47%). Mean overall global survival was 23 months with a median follow-up of 3.5 years.
These results confirm the efficacy of endobronchial brachytherapy as well as palliative or curative treatment, but the improvement of results will essentially depend on our capacity to better define our indications and underlie the necessity to perform phase III international randomised trial.
术中组织间近距离放射治疗已应用于肺癌的根治性和姑息性治疗。放射性源的植入相对于外照射具有优势，因为从源到处方点的穿透性有限，导致剂量快速下降并使周围正常组织得到保护。本研究的目的是回顾性地重新评估安托万 - 拉卡萨涅癌症中心在低剂量率（LDR）或高剂量率（HDR）支气管内近距离放射治疗方面的经验，并为未来几十年设计展望。评估基于毒性、缓解率和生存率分析。
1989年10月至1999年6月，连续治疗了31例支气管癌患者。分别有13例和18例患者接受了LDR和HDR治疗。平均年龄为65岁（范围44至79岁）。纳入标准为，姑息治疗时为无法治愈的支气管内癌症，根治性治疗时为切除后切缘有残留肿瘤，或支气管内肿瘤无法手术治疗。排除标准为病变部位不适合放置近距离放射治疗导管。并发症和临床反应的评估基于最后一次治疗后一个月及治疗结束后至少一年的内镜评估。
共进行了87个疗程：LDR治疗65个疗程，HDR治疗22个疗程。姑息组进行了36个疗程，根治组进行了51个疗程。31例患者中有7例出现急性并发症，18/31例出现晚期并发症。可评估的30例患者中完全总体缓解率为14例（47%）。平均总生存期为23个月，中位随访时间为3.5年。
这些结果证实了支气管内近距离放射治疗作为姑息或根治性治疗的有效性，但结果的改善将主要取决于我们更好地明确适应证的能力以及开展国际III期随机试验的必要性。
