Goineau Aurore, Piot Benoit, Malard Olivier, Ferron Christophe, Lisbona Albert, Cassagnau Elisabeth, Delamazure Anne-Sophie, Campion Loïc, Bardet Etienne
Department of Radiation Oncology, Institut de Cancérologie de l'Ouest, St Herblain, France.
Department of Maxillofacial Surgery, Hôtel-Dieu Hospital, University of Nantes, Nantes, France.
Brachytherapy. 2015 Jan-Feb;14(1):71-6. doi: 10.1016/j.brachy.2014.09.011. Epub 2014 Nov 6.
To evaluate the efficiency and toxicity of postoperative brachytherapy (POBT) in the treatment of resectable mobile tongue squamous cell carcinoma.
This was a retrospective single-center study of patients with SSC of the mobile tongue who were treated between August 1992 and June 2013 by glossectomy and neck dissection followed by (192)Ir interstitial brachytherapy of the tumor bed. Endpoints were local control, cancer-specific survival (CSS), overall survival (OS), and morbidity. Independent prognostic factors were analyzed in a Cox regression model.
A total of 112 patients were identified (median age, 55 years [range, 15-84]; 76% male). Patient and tumor characteristics were: T1T2N0 (85%), pN+ (13%), positive surgical margins (14%), negative margins <5 mm (29%), dysplasic margins (14%), lymphatic vessel invasion (5%), and perineural spread (5%). Median followup was 6.7 years (1.5 months to 17.7 years). Local control, CSS, and OS rates at 2 years were 79%, 81%, and 72%, respectively. The corresponding 5-year rates were 76%, 67%, and 56%, respectively. After POBT, 22% of patients presented grade ≥2 necrosis and 8% experienced chronic pain. Independent prognostic factors were positive surgical margins for poor local control and tumor recurrence and lymphatic vessel invasion for poor OS.
POBT provided good local control and better CSS and OS than reported for surgery alone. Morbidity was higher than that reported for brachytherapy alone but may be considered acceptable in a well-selected patient population at high risk of local recurrence.
评估术后近距离放射治疗（POBT）在治疗可切除的活动期舌鳞状细胞癌中的疗效和毒性。
这是一项回顾性单中心研究，研究对象为1992年8月至2013年6月期间接受舌切除术和颈部清扫术，随后对瘤床进行铱-192组织间近距离放射治疗的活动期舌鳞状细胞癌患者。观察终点为局部控制、癌症特异性生存（CSS）、总生存（OS）和发病率。在Cox回归模型中分析独立预后因素。
共纳入112例患者（中位年龄55岁[范围15 - 84岁]；76%为男性）。患者和肿瘤特征如下：T1T2N0（85%）、pN +（13%）、手术切缘阳性（14%）、阴性切缘＜5 mm（29%）、发育异常切缘（14%）、淋巴管侵犯（5%）和神经周围扩散（5%）。中位随访时间为6.7年（1.5个月至17.7年）。2年时的局部控制率、CSS率和OS率分别为79%、81%和72%。相应的5年率分别为76%、67%和56%。POBT后，22%的患者出现≥2级坏死，8%的患者经历慢性疼痛。独立预后因素为手术切缘阳性提示局部控制不佳和肿瘤复发，淋巴管侵犯提示OS不佳。
POBT提供了良好的局部控制，与单独手术相比，CSS和OS更佳。发病率高于单独近距离放射治疗报道的情况，但在精心选择的局部复发高风险患者群体中可能被认为是可接受的。
