Suh Jeffrey D, Kim Brian P, Abemayor Elliot, Sercarz Joel A, Nabili Vishad, Liu Jerome H, Juillard Guy J, Blackwell Keith E
Division of Head and Neck Surgery, University of California, Los Angeles, CA 90095-1624, USA. jsuh@mednet .ucla.edu
Otolaryngol Head Neck Surg. 2008 Dec;139(6):781-6. doi: 10.1016/j.otohns.2008.09.002.
To evaluate the outcome and complications of reirradiation of recurrent head and neck cancer after salvage surgery and microvascular reconstruction.
Retrospective.
Twelve patients underwent salvage surgery with microvascular reconstruction for recurrent or second primary head and neck cancer in a previously irradiated field. Median prior radiation therapy dose was 63.0 Gy. Patients then underwent postoperative reirradiation, and received a median total cumulative radiation dose of 115.0 Gy.
Three (25%) patients experienced acute complications (<3 months) during reirradiation. Four (33%) patients developed grade 3 or 4 late reirradiation complications (>3 months). There were no incidences of free flap failure, brain necrosis, spinal cord injury, or carotid rupture. The incidence of soft tissue necrosis and osteoradionecrosis was 8%. Six (50%) patients are alive without evidence of recurrent disease a median of 40 months after reirradiation.
Microvascular free flaps allow for maximal resection and reliable reconstruction of previously irradiated cancers before high dose reirradiation and may reduce the incidence of severe late complications and treatment related mortality.
评估挽救性手术及微血管重建术后复发性头颈癌再程放疗的疗效及并发症。
回顾性研究。
12例患者因复发性或第二原发性头颈癌在先前放疗区域接受了微血管重建的挽救性手术。既往放疗中位剂量为63.0 Gy。患者随后接受术后再程放疗，总累积放疗剂量中位值为115.0 Gy。
3例（25%）患者在再程放疗期间出现急性并发症（<3个月）。4例（33%）患者发生3级或4级晚期再程放疗并发症（>3个月）。未发生游离皮瓣坏死、脑坏死、脊髓损伤或颈动脉破裂。软组织坏死和骨放射性坏死的发生率为8%。6例（50%）患者在再程放疗后中位40个月时存活，无疾病复发迹象。
微血管游离皮瓣可在高剂量再程放疗前对先前放疗过的癌症进行最大限度的切除和可靠的重建，并可能降低严重晚期并发症的发生率及治疗相关死亡率。
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