Takácsi-Nagy Zoltán, Oberna Ferenc, Koltai Pál, Hitre Erika, Major Tibor, Fodor János, Polgár Csaba
Center of Radiotherapy, National Institute of Oncology, Budapest, Hungary.
Brachytherapy. 2013 Nov-Dec;12(6):535-41. doi: 10.1016/j.brachy.2013.07.001. Epub 2013 Aug 27.
To report the long-term results of a prospective, nonrandomized clinical trial using high-dose-rate (HDR) brachytherapy (BT) for the management of base of the tongue (BOT) tumors.
Between January 1992 and June 2011, 60 patients (mean age, 57 years; range, 36-78 years) with T1-T4 and N0-3 carcinoma of BOT were treated. Fifty-six patients (93%) had advanced (Stage III-IV) disease. HDR BT boost (mean dose, 17 Gy; range, 12-30 Gy) was delivered after 50-70 Gy (mean 62 Gy) locoregional external beam irradiation. Seventeen patients (28%) received radiochemotherapy (RCT) with cisplatin.
The 5-year actuarial rate of local tumor control, locoregional tumor control, overall survival (OS), and cancer-specific survival (CSS) was 57%, 50%, 47%, and 61%, respectively. OS was significantly better in patients (n=17) receiving RCT (69% vs. 39%; p=0.005). Delayed soft-tissue ulceration occurred in seven patients (12%). Only one patient (<2%) developed osteoradionecrosis. In univariate analysis, the tumor size (T1-T2-T3 vs. T4) was found to have a significant effect on CSS (p=0.043), whereas the nodal status (N0 vs. N+) affected locoregional tumor control (p=0.042), OS (p=0.002), and CSS (p=0.015). Low histologic grade (1-2) was associated with better CSS (p=0.020), whereas RCT significantly improved OS (p=0.012).
External beam irradiation combined with interstitial HDR BT boost results in good local tumor control with an acceptable rate of late side effects in patients with BOT carcinoma. RCT improves OS. Our results are similar to those reported with traditional low-dose-rate BT implants.
报告一项前瞻性、非随机临床试验的长期结果，该试验使用高剂量率（HDR）近距离放射治疗（BT）来治疗舌根部（BOT）肿瘤。
1992年1月至2011年6月期间，对60例T1 - T4和N0 - 3期的BOT癌患者进行了治疗（平均年龄57岁；范围36 - 78岁）。56例患者（93%）患有晚期（III - IV期）疾病。在局部区域外照射50 - 70 Gy（平均62 Gy）后给予HDR BT增敏（平均剂量17 Gy；范围12 - 30 Gy）。17例患者（28%）接受了顺铂同步放化疗（RCT）。
局部肿瘤控制、局部区域肿瘤控制、总生存（OS）和癌症特异性生存（CSS）的5年精算率分别为57%、50%、47%和61%。接受RCT的患者（n = 17）的OS明显更好（69%对39%；p = 0.005）。7例患者（12%）出现延迟性软组织溃疡。仅1例患者（<2%）发生放射性骨坏死。单因素分析中，发现肿瘤大小（T1 - T2 - T3对T4）对CSS有显著影响（p = 0.043），而淋巴结状态（N0对N +）影响局部区域肿瘤控制（p = 0.042）、OS（p = 0.002）和CSS（p = 0.015）。低组织学分级（1 - 2级）与更好的CSS相关（p = 0.020），而RCT显著改善了OS（p = 0.012）。
外照射联合组织间HDR BT增敏可实现良好的局部肿瘤控制，BOT癌患者的晚期副作用发生率可接受。RCT改善了OS。我们的结果与传统低剂量率BT植入报道的结果相似。
