Department of Radiation Oncology, Klinikum Offenbach, Germany.
Radiother Oncol. 2011 Jan;98(1):57-62. doi: 10.1016/j.radonc.2010.10.025. Epub 2010 Dec 2.
Despite significant improvements in the treatment of head and neck cancer (HNC), lymph node recurrences remain a clinical challenge after primary radiotherapy. The value of interstitial (IRT) brachytherapy (BRT) for control of lymph node recurrence remains unclear. In order to clarify its role a retrospective review was undertaken on the value of computed tomography (CT)-guided IRT high-dose-rate (HDR)-BRT in isolated recurrent disease from HNC.
From 2000 to 2007, 74 patients were treated for inoperable recurrent cervical lymphadenopathy. All patients had previously been treated with radical radiotherapy or chemoradiation with or without surgery. The HDR-BRT delivered a median salvage dose of 30.0 Gy (range, 12.0-36.0 Gy) in twice-daily fractions of 2.0-5.0 Gy in 71 patients and of 30.0 Gy (range, 10.0-36.0 Gy) in once-daily fractions of 6.0-10.0 Gy in three patients.
The overall and disease-free survival rates at one, two and three years were 42%, 19%, 6%, and 42%, 37% and 19%, respectively. The local control probability at one, two and three years was 67% at all three time points. Grade III-IV complications occurred in 13% of patients.
In patients with inoperable recurrent neck disease from HNC, hypofractionated accelerated CT-guided IRT-HDR-BRT can play an important role in providing palliation and tumor control.
尽管头颈部癌症（HNC）的治疗有了显著改善，但在原发性放疗后，淋巴结复发仍然是一个临床挑战。间质（IRT）近距离放射治疗（BRT）控制淋巴结复发的价值仍不清楚。为了阐明其作用，我们对 74 例因 HNC 复发而无法手术的颈部淋巴结复发患者进行了 CT 引导的 IRT 高剂量率（HDR）BRT 的回顾性研究。
从 2000 年到 2007 年，有 74 例不能手术的复发性颈部淋巴结病患者接受了治疗。所有患者均接受过根治性放疗或放化疗，联合或不联合手术。HDR-BRT 对 71 例患者的中位挽救剂量为 30.0Gy（范围 12.0-36.0Gy），每日两次，每次 2.0-5.0Gy；对 3 例患者的中位挽救剂量为 30.0Gy（范围 10.0-36.0Gy），每日一次，每次 6.0-10.0Gy。
1、2、3 年的总生存率和无病生存率分别为 42%、19%、6%和 42%、37%、19%。1、2、3 年局部控制率分别为 67%。有 13%的患者发生 3 级或 4 级并发症。
对于不能手术的 HNC 复发性颈部疾病患者，分割加速 CT 引导 IRT-HDR-BRT 可在缓解肿瘤和控制肿瘤方面发挥重要作用。
