Gibbs Iris C, Le Quynh-Thu, Shah Rachit D, Terris David J, Fee Willard E, Goffinet Don R
Department of Radiation Oncology, Stanford University, Stanford, CA 94305-5302, USA.
Int J Radiat Oncol Biol Phys. 2003 Oct 1;57(2):489-94. doi: 10.1016/s0360-3016(03)00597-2.
To assess long-term efficacy and toxicity associated with external beam irradiation (EBRT) and interstitial (192)Ir implantation for the treatment of squamous carcinoma of the base of tongue.
Between April 1975 and December 1993, 41 patients with base-of-tongue carcinomas were treated with (192)Ir interstitial implants after EBRT at Stanford University. One patient had Stage I, 6 had Stage II, 7 had Stage III, and 27 had Stage IV tumors. Twenty-eight patients had cervical lymph node involvement at diagnosis. All received EBRT to a median dose of 50 Gy (range 48.9-68 Gy) to the primary tumor and regional lymph nodes before brachytherapy. Interstitial implant was performed 2-4 weeks after EBRT. Intraoperatively, nylon catheters were placed via steel trocars into the base of tongue, glossotonsillar groove, and pharyngo-epiglottic fold using a catheter looping technique. Twenty-three of 28 node-positive patients also underwent simultaneous neck dissections. Postoperatively, the (192)Ir seeds were inserted and allowed to remain in place for approximately 35 h to achieve a median tumor dose of 26 Gy (range 20-34 Gy) to a median volume of 73 cc. Survival, local control, and complications were assessed.
With a median follow-up of 62 months (range 9-215) for all patients and 90 months for alive patients, the 5-year Kaplan-Meier survival estimate was 66%. The 5-year local control rate was 82%, with 7 patients recurring locally, 2 of whom were salvaged with surgery. Nodal control was achieved in 93% of patients with either EBRT alone or in combination with neck dissection. The 5-year freedom from distant metastasis rate was 83%. Acute complications included transient bleeding (5%) and infection (8%). Late complication included soft-tissue necrosis/ulceration (7%), osteoradionecrosis (5%), and xerostomia.
Base-of-tongue carcinoma can be effectively treated with EBRT and (192)Ir implant boost. Local control is excellent and complication rates are acceptable.
评估外照射放疗（EBRT）联合组织间（192）铱植入治疗舌根部鳞癌的长期疗效和毒性。
1975年4月至1993年12月期间，斯坦福大学对41例舌根部癌患者在EBRT后进行了（192）铱组织间植入治疗。1例患者为I期，6例为II期，7例为III期，27例为IV期肿瘤。28例患者在诊断时伴有颈部淋巴结受累。所有患者在近距离放疗前均接受EBRT，原发肿瘤和区域淋巴结的中位剂量为50 Gy（范围48.9 - 68 Gy）。组织间植入在EBRT后2 - 4周进行。术中，通过钢针套管将尼龙导管经导管环扎技术置入舌根部、舌扁桃体沟和咽会厌襞。28例淋巴结阳性患者中有23例同时接受了颈部清扫术。术后，插入（192）铱籽源并留置约35小时，以使中位体积为73 cc的肿瘤中位剂量达到26 Gy（范围20 - 34 Gy）。评估生存率、局部控制率和并发症。
所有患者的中位随访时间为62个月（范围9 - 215个月），存活患者为90个月，5年Kaplan - Meier生存率估计为66%。5年局部控制率为82%，7例患者局部复发，其中2例经手术挽救。单独使用EBRT或联合颈部清扫术的患者中，93%实现了淋巴结控制。5年无远处转移率为83%。急性并发症包括短暂出血（5%）和感染（8%）。晚期并发症包括软组织坏死/溃疡（7%）、放射性骨坏死（5%）和口干。
舌根部癌可通过EBRT和（192）铱植入增强治疗得到有效治疗。局部控制良好，并发症发生率可接受。
