Biswal B M, Ruzman N, Ahmad N M, Zakaria A
Department of Nuclear Medicine, Radiotherapy & Oncology, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia.
Malays J Med Sci. 2000 Jan;7(1):54-9.
Short course hypo-fractionated radiotherapy is a standard regime for the palliation of stage IV head and neck cancers. However few patients respond favorably and require further radiotherapy in curative intent. We have used split-course radiotherapy technique to find out this conversion rate from palliative to curative intent. This was a prospective study conducted from November 1998 to October 1999; twenty-six (26) patients with stage IV head & neck cancers were treated with a hypofractionated regime of radiotherapy. A tumor dose of 30 Gy in 10 fractions [time dose fraction (TDF) 62] over 2 weeks was delivered using a 6 MV linear accelerator. A conventional 2 field or 3 field technique was used. Patients were assessed for the regression of tumor on fifth day, tenth day of radiotherapy and 4 weeks after the completion of radiotherapy. Patients showing complete response and good partial response were allowed to receive further radiotherapy of 30 Gy in 15 fractions [TDF 49]. There were 21 males and 5 females in the study with a median age of 44 years (range 19-77 years). All patients completed the initial regime. Complete responses were observed among 14 patients (54%); partial response in 6 patients (23%), and no response was seen among 6 patients (23%). Sixteen patients (61%) were suitable for radical radiotherapy after phase-I course of the above schedule. Seventeen patients (65%) showed an improvement in the general well being with a better quality of life. One year actuarial survival was (76%), with a median survival time of 12 months. Split-course technique is a useful radiotherapy treatment in stage IV head and neck cancers to distinguish between the subset of patients who would require curative treatment and who would not.
短疗程低分割放疗是IV期头颈癌姑息治疗的标准方案。然而，很少有患者反应良好并需要进行根治性放疗。我们采用了分段放疗技术来确定从姑息治疗转为根治性治疗的转化率。这是一项于1998年11月至1999年10月进行的前瞻性研究；26例IV期头颈癌患者接受了低分割放疗方案。使用6兆伏直线加速器在2周内分10次给予30 Gy的肿瘤剂量（时间剂量分数[TDF] 62）。采用传统的两野或三野技术。在放疗的第5天、第10天以及放疗完成后4周对患者进行肿瘤消退评估。表现出完全缓解和良好部分缓解的患者被允许接受进一步的15次分割、30 Gy的放疗（TDF 49）。研究中有21名男性和5名女性，中位年龄为44岁（范围19 - 77岁）。所有患者均完成了初始方案。14例患者（54%）观察到完全缓解；6例患者（23%）部分缓解，6例患者（23%）无反应。16例患者（61%）在上述方案的I期疗程后适合进行根治性放疗。17例患者（65%）的总体健康状况有所改善，生活质量提高。一年精算生存率为（76%），中位生存时间为12个月。分段放疗技术在IV期头颈癌中是一种有用的放疗治疗方法，可区分出需要根治性治疗和不需要根治性治疗的患者亚组。
