Department of Radiology, Kyoto Prefectural University of Medicine, 465 Kajiicho Kawaramachi Hirokoji, Kamigyo-ku, Kyoto 602-8566 Japan.
Radiat Oncol. 2010 Dec 9;5:116. doi: 10.1186/1748-717X-5-116.
To examine the role of brachytherapy for aged patients 80 or more in the trend of rapidly increasing number.
We examined the outcomes for elderly patients with node negative oral tongue cancer (T1-3N0M0) treated with brachytherapy. The 21 patients (2 T1, 14 T2, and 5 T3 cases) ranged in age from 80 to 89 years (median 81), and their cancer was pathologically confirmed. All patients underwent definitive radiation therapy, with low dose rate (LDR) Ra-226 brachytherapy (n = 4; median 70Gy), with Ir-192 (n = 12; 70Gy), with Au-198 (n = 1) or with high dose rate (HDR) Ir-192 brachytherapy (n = 4; 60 Gy). Eight patients also underwent external radiotherapy (median 30 Gy). The period of observation ranged from 13 months to 14 years (median 2.5 years). We selected 226 population matched younger counterpart from our medical chart.
Definitive radiation therapy was completed for all 21 patients (100%), and acute grade 2-3 mucositis related to the therapy was tolerable. Local control (initial complete response) was attained in 19 of 21 patients (90%). The 2-year and 5-year local control rates were 91%, (100% for T1, 83% for T2 and 80% for T3 tumors after 2 years). These figures was not inferior to that of younger counterpart (82% at 5-year, n.s.). The cause-specific survival rate was 83% and the regional control rate 84% at the 2-years follow-up. However, 12 patients died because of intercurrent diseases or senility, resulting in overall survival rates of 55% at 2 years and 34% at 5 years.
Age is not a limiting factor for brachytherapy for appropriately selected elderly patients, and brachytherapy achieved good local control with acceptable morbidity.
研究高龄患者（80 岁及以上）在数量迅速增加的趋势中接受近距离放射治疗的作用。
我们研究了接受近距离放射治疗的淋巴结阴性口腔舌癌（T1-3N0M0）老年患者的结局。21 例患者（2 例 T1、14 例 T2、5 例 T3）年龄 80 至 89 岁（中位年龄 81 岁），且经病理证实为癌症。所有患者均接受根治性放疗，采用低剂量率（LDR）镭-226 近距离放射治疗（n = 4；中位剂量 70Gy）、铱-192（n = 12；70Gy）、金-198（n = 1）或高剂量率（HDR）铱-192 近距离放射治疗（n = 4；60Gy）。8 例患者还接受了外照射放疗（中位剂量 30Gy）。观察期为 13 个月至 14 年（中位 2.5 年）。我们从病历中选择了 226 名年龄匹配的年轻对照组患者。
21 例患者（100%）均完成了根治性放疗，且可耐受与治疗相关的急性 2-3 级黏膜炎。21 例患者中 19 例（90%）达到初始完全缓解的局部控制。2 年和 5 年局部控制率分别为 91%（T1 为 100%，T2 为 83%，T3 为 80%）。这些数据与年轻对照组（5 年时为 82%，无统计学差异）相当。2 年时的疾病特异性生存率为 83%，区域控制率为 84%。然而，12 例患者因并发疾病或衰老死亡，导致 2 年时的总生存率为 55%，5 年时为 34%。
对于选择适当的高龄患者，年龄不是近距离放射治疗的限制因素，且近距离放射治疗可获得良好的局部控制效果，同时发病率可接受。
