Pernot M, Malissard L, Taghian A, Hoffstetter S, Luporsi E, Forçard J J, Aletti P, Bey P
Department of Brachytherapy, Centre Alexis Vautrin, Vandoeuvre-lès-Nancy, France.
Int J Radiat Oncol Biol Phys. 1992;23(4):715-23. doi: 10.1016/0360-3016(92)90643-v.
From 1977 to 1987, 277 patients with velotonsillar cancer (oropharyngeal cancer excluding base of tongue and valleculae) were treated by brachytherapy either alone (14 patients) or combined with external beam irradiation (263 patients) using a new afterloading Iridium-192 technique. The distribution of patients according to the localisation was as follows: 106 tonsillar region, 98 soft palate, 45 anterior pillar, 8 posterior pillar and 20 pharyngoglossal sulcus. According to the UICC TNM classification of 1979, the patients were staged as follows: 65 T1, 103 T2, 101 T3, 8 TX. 172 patients were NO, 74 N1, 3 N2, 20 N3 et 8 NX. According to the tumor extension, the 5 year actuarial local control, locoregional control, specific survival and overall survival by T stage (T1 [65 pts], T2 [103 pts.], T3 [101 pts]) were respectively: local control: 89%, 86%, 69%; locoregional control: 84%, 80%, 67%; specific survival (excluding patients dead with intercurrent disease or second cancer): 78%, 62%, 46%; overall survival: 62%, 53%, 43%. No local recurrence was detected after 3 years. According to the localization, the tumors arising from the tonsillar region, the soft palate and the posterior pillars (A Group) had a better prognosis than the tumors arising from the anterior pillars and glossotonsillar sulcus (B Group). The complications were classified into four grades according to their extension and duration: Grade 1 (minor) with very small tissue ulcer which healed within 2 months with medical treatment (20%). Grade 2 (moderate) (5%), grade 3 (severe) (1.4%), grade 4 (fatal) (0.4%). The dose rate seemed to be relatively higher in patients with grade 2 and 3 complications (70 cGy per hour on average) versus the dose rate of patients without complications (50 cGy per hour) but the difference was not significant. In conclusion, the brachytherapy boost after external irradiation can be performed under favourable conditions with an acceptable rate of complications. It was set out in order to attempt to improve the local control of the tumor while preserving the salivary function and lessening the muscular fibrosis. It shows how experienced the team is, however only a randomized study would allow to state whether this technique brings about a real improvement especially as for tumors T2 or T3.
1977年至1987年期间，277例腭扁桃体癌（不包括舌根和会厌谷的口咽癌）患者接受了近距离放射治疗，其中14例单独接受近距离放射治疗，263例采用新型后装铱-192技术联合外照射。根据肿瘤部位，患者分布如下：扁桃体区106例，软腭98例，前柱45例，后柱8例，咽舌沟20例。根据1979年国际抗癌联盟（UICC）TNM分类，患者分期如下：T1期65例，T2期103例，T3期101例，TX期8例。N0期172例，N1期74例，N2期3例，N3期20例，NX期8例。根据肿瘤侵犯范围，T分期（T1[65例]、T2[103例]、T3[101例]）患者的5年精算局部控制率、区域控制率、特异性生存率和总生存率分别为：局部控制率：89%、86%、69%；区域控制率：84%、80%、67%；特异性生存率（不包括死于并发疾病或第二原发癌的患者）：78%、62%、46%；总生存率：62%、53%、43%。3年后未检测到局部复发。根据肿瘤部位，起源于扁桃体区、软腭和后柱的肿瘤（A组）预后优于起源于前柱和舌扁桃体沟的肿瘤（B组）。并发症根据其范围和持续时间分为四级：1级（轻度），组织溃疡非常小，经药物治疗2个月内愈合（20%）。2级（中度）（5%），3级（重度）（1.4%），4级（致命）（0.4%）。2级和3级并发症患者的剂量率似乎相对较高（平均每小时70 cGy），而无并发症患者的剂量率为每小时50 cGy，但差异无统计学意义。总之，外照射后进行近距离放疗加强可以在有利条件下进行，并发症发生率可以接受。开展此项研究是为了在保留唾液功能和减轻肌肉纤维化的同时，试图提高肿瘤的局部控制率。这显示了该团队经验丰富，然而只有随机研究才能确定该技术是否能带来真正的改善，尤其是对于T2或T3期肿瘤。
