Patra Niladri B, Goswami Jyotirup, Basu Swapnendu, Chatterjee Kaushik, Sarkar Shyamal K
Department of Radiotherapy, Medical College Hospital, Kolkata, India.
Department of Radiotherapy, Medical College Hospital, Kolkata, India.
Brachytherapy. 2009 Apr-Jun;8(2):248-254. doi: 10.1016/j.brachy.2008.12.006. Epub 2009 Feb 20.
This study is to assess efficacy and toxicity associated with external beam radiation therapy (EBRT) and high dose rate (HDR) interstitial Iridium-192 ((192)Ir) brachytherapy for the treatment of squamous carcinoma of the oropharynx and oral cavity.
Between July 2004 and June 2006, 33 patients with oropharynx and oral cavity carcinomas were treated with (192)Ir interstitial implants after EBRT at Medical College Hospital, Kolkata. Fifteen patients had early stage disease (Stage I and II) and 18 had advanced stage disease (Stage III and IV). All received EBRT to a median dose of 50Gy (range, 46-66Gy) to the primary tumor and regional lymph nodes before brachytherapy. Node-positive patients with residual neck disease also underwent neck dissection. Brachytherapy dose (HDR) in combination with EBRT varied from 14 to 21Gy, 3-3.5Gy per fraction, two fractions daily. Locoregional control, freedom from disease, and complications were assessed.
Followup duration was between 18 and 40 months. At the end of treatment with radiation, 79% achieved complete response (CR) (p<0.009), 21% achieved partial response (PR) and the ultimate control rate (including surgical salvage) was 100% and 78% for early and advanced disease, respectively (p<0.108). Three (9%) patients failed locally after CR. No distant metastasis was seen during followup. Grade 3 mucositis was seen in 12% cases. Transient hemorrhage occurred in 3 (9%) patients and local infection in 1 (3%) patient. Severe dysphagia was seen in 1 (3%) patient. 5/33 (15%) patients experienced xerostomia (Grade 3-4), but almost all patients had Grade 1-2 xerostomia.
Oropharyngeal and oral cavity tumors can be effectively treated with (192)Ir implant boost after EBRT. Local control is excellent and complication rates are acceptable.
本研究旨在评估外照射放疗（EBRT）和高剂量率（HDR）组织间铱-192（¹⁹²Ir）近距离放疗治疗口咽和口腔鳞状细胞癌的疗效及毒性。
2004年7月至2006年6月期间，加尔各答医学院医院对33例口咽和口腔癌患者在EBRT后进行了¹⁹²Ir组织间植入治疗。15例患者为早期疾病（Ⅰ期和Ⅱ期），18例为晚期疾病（Ⅲ期和Ⅳ期）。所有患者在近距离放疗前，对原发肿瘤和区域淋巴结接受了中位剂量为50Gy（范围46 - 66Gy）的EBRT。颈部淋巴结阳性且有残留颈部病变的患者也接受了颈部清扫术。与EBRT联合的近距离放疗剂量（HDR）为14至21Gy，每次分割剂量为3 - 3.5Gy，每天两次。评估局部区域控制、无病生存情况及并发症。
随访时间为18至40个月。放疗结束时，79%达到完全缓解（CR）（p<0.009），21%达到部分缓解（PR），早期和晚期疾病的最终控制率（包括手术挽救）分别为100%和78%（p<0.108）。3例（9%）患者在CR后局部复发。随访期间未见远处转移。12%的病例出现3级黏膜炎。3例（9%）患者发生短暂出血，1例（3%）患者发生局部感染。1例（3%）患者出现严重吞咽困难。33例患者中有5例（15%）出现口干（3 - 4级），但几乎所有患者都有1 - 2级口干。
口咽和口腔肿瘤在EBRT后采用¹⁹²Ir植入强化治疗可得到有效治疗。局部控制良好，并发症发生率可接受。
