Grimard Laval, Esche Bernd, Lamothe André, Spaans Johanna N
Department of Radiation Oncology, The Ottawa Hospital Cancer Centre, Ottawa, ON, Canada.
Brachytherapy. 2009 Jul-Sep;8(3):284-9. doi: 10.1016/j.brachy.2008.12.007. Epub 2009 May 15.
Persistent disease after definitive external beam radiation therapy for head and neck (H&N) malignancies negatively impacts survival. In this series, the effectiveness of low-dose-rate brachytherapy in the management of persistent H&N disease is explored.
All patients who received brachytherapy for persistent H&N disease between 1987 and 2002 were identified. Tumor and treatment characteristics and toxicities were recorded. Progression-free survival and overall survival estimates were generated. The influence of prognostic factors was determined.
Twelve patients were analyzable. Brachytherapy was given curatively (n=4) in patients not amenable to surgery or in combination with surgical dissection to avoid carotid resection (n=8). Seven patients had disease progression with a median time to progression of 11 months (95% confidence interval: 0-22.9). The only negative prognostic factor was time to re-treatment (brachytherapy >4 months) after definitive treatment (p=0.003). Overall survival at 1 and 5 years was 50% and 21%, respectively. Toxicity was limited to one major complication (fistula) and five minor toxicities: low-grade radionecrosis (n=2), cellulitis (n=1), and wound dehiscence (n=2).
In patients with persistent disease, brachytherapy is an appealing re-treatment alternative. When combined with neck dissection, brachytherapy yields less morbidity than the surgical alternative of carotid resection.
头颈部（H&N）恶性肿瘤在接受确定性外照射放疗后出现持续性疾病会对生存产生负面影响。在本系列研究中，探讨了低剂量率近距离放疗在治疗持续性H&N疾病中的有效性。
确定了1987年至2002年间所有因持续性H&N疾病接受近距离放疗的患者。记录肿瘤和治疗特征及毒性反应。生成无进展生存期和总生存期估计值。确定预后因素的影响。
12例患者可进行分析。对于不宜手术的患者（n = 4）或为避免颈动脉切除而与手术切除联合进行近距离放疗（n = 8）。7例患者出现疾病进展，中位进展时间为11个月（95%置信区间：0 - 22.9）。唯一的负面预后因素是确定性治疗后再次治疗的时间（近距离放疗>4个月）（p = 0.003）。1年和5年的总生存率分别为50%和21%。毒性反应仅限于1例主要并发症（瘘管）和5例轻微毒性反应：低度放射性坏死（n = 2）、蜂窝织炎（n = 1）和伤口裂开（n = 2）。
对于患有持续性疾病的患者，近距离放疗是一种有吸引力的再次治疗选择。与颈部清扫术联合使用时，近距离放疗产生的发病率低于颈动脉切除的手术替代方案。
