Chen Allen M, Bucci M Kara, Singer Mark I, Garcia Joaquin, Kaplan Michael J, Chan Albert S, Phillips Theodore L
Department of Radiation Oncology, University of California, San Francisco, Comprehensive Cancer Center, San Francisco, CA.
Int J Radiat Oncol Biol Phys. 2007 Jan 1;67(1):122-9. doi: 10.1016/j.ijrobp.2006.08.038. Epub 2006 Nov 2.
To review a single-institutional experience with the use of intraoperative radiation therapy (IORT) for recurrent head-and-neck cancer.
Between 1991 and 2004, 137 patients were treated with gross total resection and IORT for recurrence or persistence of locoregional cancer of the head and neck. One hundred and thirteen patients (83%) had previously received external beam radiation as a component of definitive therapy. Ninety-four patients (69%) had squamous cell histology. Final surgical margins were microscopically positive in 56 patients (41%). IORT was delivered using either a modified linear accelerator or a mobile electron unit and was administered as a single fraction to a median dose of 15 Gy (range, 10-18 Gy). Median follow-up among surviving patients was 41 months (range, 3-122 months).
The 1-year, 2-year, and 3-year estimates of in-field control after salvage surgery and IORT were 70%, 64%, and 61%, respectively. Positive margins at the time of IORT predicted for in-field failure (p = 0.001). The 3-year rates of locoregional control, distant metastasis-free survival, and overall survival were 51%, 46%, and 36%, respectively. There were no perioperative fatalities. Complications included wound infection (4 patients), orocutaneous fistula (2 patients), flap necrosis (1 patient), trismus (1 patient), and neuropathy (1 patient).
Intraoperative RT results in effective disease control with acceptable toxicity and should be considered for selected patients with recurrent or persistent cancers of the head and neck.
回顾单机构使用术中放射治疗（IORT）治疗复发性头颈癌的经验。
1991年至2004年间，137例患者因头颈部局部区域癌复发或持续存在接受了根治性切除及IORT治疗。113例患者（83%）先前接受过外照射作为根治性治疗的一部分。94例患者（69%）为鳞状细胞组织学类型。56例患者（41%）手术切缘镜下阳性。IORT使用改良直线加速器或移动式电子装置进行，单次给予中位剂量15 Gy（范围10 - 18 Gy）。存活患者的中位随访时间为41个月（范围3 - 122个月）。
挽救性手术及IORT后1年、2年和3年的瘤床控制率估计分别为70%、64%和61%。IORT时切缘阳性预示瘤床失败（p = 0.001）。3年局部区域控制率、无远处转移生存率和总生存率分别为51%、46%和36%。无围手术期死亡。并发症包括伤口感染（4例）、口皮瘘（2例）、皮瓣坏死（1例）、牙关紧闭（1例）和神经病变（1例）。
术中放疗可有效控制疾病，毒性可接受，对于部分头颈部复发或持续性癌症患者应考虑采用。
