Strnad Vratislav, Lotter Michael, Kreppner Stephan, Fietkau Rainer
Division of Interventional Radiation Oncology, Department of Radiation Oncology, University Hospital Erlangen, Erlangen, Germany.
Brachytherapy. 2013 Nov-Dec;12(6):521-7. doi: 10.1016/j.brachy.2013.07.002. Epub 2013 Aug 16.
To assess the long-term results of protocol-based pulsed-dose-rate (PDR) interstitial brachytherapy (iBT) in 385 patients with head and neck cancer who underwent PDR-iBT preferably after minimal, nonmutilating surgery.
From 1997 to 2009, a total of 385 patients received protocol-based PDR-iBT for head and neck cancer. Brachytherapy was preceded by surgery in most of our patients (326/385, 84.7%). Altogether, 246 of 385 patients (63.9%) received iBT alone and 135 of 385 patients (36.1%) in combination with external beam radiation therapy. The analysis was done after a median followup of 63 months.
The 5-, 10-, and 15-year local relapse-free survival rates according to Kaplan-Meier test for all analyzed patients were 85.8%, 83.1%, and 80.2%, respectively. The 5-, 10-, and 15-year overall survival and disease-free survival rates were 68.9%, 52.2%, and 44.1%, and 81.3%, 79.3%, and 76.3%, respectively. For N0-/N1- vs. N2-patients, we observed significantly different 5-year local recurrence-free survival rates with values of 92.3% and 73.7%, respectively (p=0.007). No other patient or treatment-related parameters had a significant influence on treatment results. Serious late side effects, such as soft tissue or bone necrosis, were observed in 39 of 385 patients (10.2%) and 18 of 385 patients (4.9%), respectively.
The PDR-iBT with 0.4-0.7Gy each hour, 24h per day for patients with head and neck cancer is a proven, effective, and safe treatment method with excellent long-term data.
评估基于方案的脉冲剂量率（PDR）组织间近距离放射治疗（iBT）对385例头颈癌患者的长期疗效，这些患者在尽量减少毁伤性手术之后优选接受了PDR-iBT治疗。
1997年至2009年，共有385例患者接受了基于方案的头颈癌PDR-iBT治疗。在我们的大多数患者（326/385，84.7%）中，近距离放射治疗之前先进行了手术。总共，385例患者中有246例（63.9%）单独接受了iBT，385例患者中有135例（36.1%）联合外照射放疗。分析在中位随访63个月后进行。
根据Kaplan-Meier检验，所有分析患者的5年、10年和15年局部无复发生存率分别为85.8%、83.1%和80.2%。5年、10年和15年总生存率和无病生存率分别为68.9%、52.2%和44.1%，以及81.3%、79.3%和76.3%。对于N0-/N1-与N2期患者，我们观察到5年局部无复发生存率有显著差异，分别为92.3%和73.7%（p=0.007）。没有其他患者或治疗相关参数对治疗结果有显著影响。分别在385例患者中有39例（10.2%）和385例患者中有18例（4.9%）观察到严重的晚期副作用，如软组织或骨坏死。
对头颈癌患者采用每小时0.4 - 0.7Gy、每天24小时的PDR-iBT是一种经过验证的、有效且安全的治疗方法，具有出色的长期数据。
