Feldman Jon, Appelbaum Limor, Sela Mordechay, Voskoboinik Ninel, Kadouri Sarit, Weinberger Jeffrey, Orion Itzhak, Meirovitz Amichay
Oncology Department, Radiation Therapy Unit, Hadassah - Heberew University Medical Center, PO Box 12000, Jerusalem, (9112001), Israel.
Department of Nuclear Engineering, Ben Gurion University of the Negev, Beer Sheva, (84105), Israel.
Radiat Oncol. 2014 Dec 23;9:271. doi: 10.1186/s13014-014-0271-x.
PURPOSE/OBJECTIVES: The purpose of this study is to describe a novel brachytherapy technique for lip Squamous Cell Carcinoma, utilizing a customized mold with embedded brachytherapy sleeves, which separates the lip from the mandible, and improves dose homogeneity.
Seven patients with T2 lip cancer treated with a "sandwich" technique of High Dose Rate (HDR) brachytherapy to the lip, consisting of interstitial catheters and a customized mold with embedded catheters, were reviewed for dosimetry and outcome using 3D planning. Dosimetric comparison was made between the "sandwich" technique to "classic" - interstitial catheters only plan. We compared dose volume histograms for Clinical Tumor Volume (CTV), normal tissue "hot spots" and mandible dose. We are reporting according to the ICRU 58 and calculated the Conformal Index (COIN) to show the advantage of our technique.
The seven patients (ages 36-81 years, male) had median follow-up of 47 months. Four patients received Brachytherapy and External Beam Radiation Therapy, 3 patients received brachytherapy alone. All achieved local control, with excellent esthetic and functional results. All patients are disease free. The Customized Mold Sandwich technique (CMS) reduced the high dose region receiving 150% (V150) by an average of 20% (range 1-47%), The low dose region (les then 90% of the prescribed dose) improved by 73% in average by using the CMS technique. The COIN value for the CMS was in average 0.92 as opposed to 0.88 for the interstitial catheter only. All differences (excluding the low dose region) were statistically significant.
The CMS technique significantly reduces the high dose volume and increases treatment homogeneity. This may reduce the potential toxicity to the lip and adjacent mandible, and results in excellent tumor control, cosmetic and functionality.
目的/目标：本研究的目的是描述一种用于唇部鳞状细胞癌的新型近距离放射治疗技术，该技术使用带有嵌入式近距离放射治疗套管的定制模具，将唇部与下颌骨分开，并提高剂量均匀性。
回顾了7例采用高剂量率（HDR）近距离放射治疗唇部的“三明治”技术治疗的T2期唇癌患者，该技术包括组织间导管和带有嵌入式导管的定制模具，使用三维计划对剂量学和结果进行评估。对“三明治”技术与仅使用组织间导管的“经典”计划进行剂量学比较。比较了临床肿瘤体积（CTV）、正常组织“热点”和下颌骨剂量的剂量体积直方图。我们根据ICRU 58报告，并计算适形指数（COIN）以显示我们技术的优势。
7例患者（年龄36 - 81岁，男性）的中位随访时间为47个月。4例患者接受了近距离放射治疗和外照射放疗，3例患者仅接受了近距离放射治疗。所有患者均实现了局部控制，获得了良好的美学和功能效果。所有患者均无疾病。定制模具三明治技术（CMS）使接受150%（V150）的高剂量区域平均减少了20%（范围为1 - 47%），使用CMS技术使低剂量区域（低于规定剂量的90%）平均改善了73%。CMS的COIN值平均为0.92，而仅使用组织间导管的为0.88。所有差异（不包括低剂量区域）均具有统计学意义。
CMS技术显著减少了高剂量体积并提高了治疗均匀性。这可能降低对唇部和相邻下颌骨的潜在毒性，并实现出色的肿瘤控制、美容效果和功能。
