Strnad Vratislav, Lotter Michael, Kreppner Stephan, Fietkau Rainer
Dept. of Radiation Oncology, University Hospital Erlangen, Universitätsstr. 27, 91052, Erlangen, Germany,
Strahlenther Onkol. 2015 Jun;191(6):495-500. doi: 10.1007/s00066-014-0809-8. Epub 2015 Jan 10.
To assess the long-term results of protocol-based interstitial pulsed-dose-rate (PDR) brachytherapy as reirradiation combined with simultaneous chemotherapy and interstitial hyperthermia in selected patients with recurrent head and neck tumors.
A total of 104 patients with biopsy-proven recurrent head and neck cancer were treated with interstitial PDR brachytherapy. Salvage surgery had also been undergone by 53/104 (51%) patients (R1 or R2 resection in > 80% of patients). Salvage brachytherapy alone was administered in 81 patients (78%), with a median total dose of 56.7 Gy. Salvage brachytherapy in combination with external beam radiotherapy (EBRT) was performed in 23/104 patients (32%), using a median total dose of DREF = 24 Gy. Simultaneously to PDR brachytherapy, concomitant chemotherapy was administered in 58/104 (55.8%) patients. A single session of interstitial hyperthermia was also used to treat 33/104 (31.7%) patients. The analysis was performed after a median follow-up of 60 months.
Calculated according to Kaplan-Meier, local tumor control rates after 2, 5, and 10 years were 92.5, 82.4, and 58.9%, respectively. Comparing results of salvage PDR brachytherapy with or without simultaneous chemotherapy, the 10-year local control rates were 76 vs. 39% (p = 0014), respectively. No other patient- or treatment-related parameters had a significant influence on treatment results. Soft tissue necrosis or bone necrosis developed in 18/104 (17.3%) and 11/104 (9.6%) patients, respectively, but only 3% of patients required surgical treatment.
PDR interstitial brachytherapy with simultaneous chemotherapy is a very effective and, in experienced hands, also a safe treatment modality in selected patients with head and neck cancer in previously irradiated areas.
评估基于方案的组织间脉冲剂量率（PDR）近距离放射治疗作为再程放疗联合同步化疗及组织间热疗在部分复发性头颈部肿瘤患者中的长期疗效。
共有104例经活检证实为复发性头颈部癌的患者接受了组织间PDR近距离放射治疗。104例患者中有53例（51%）还接受了挽救性手术（超过80%的患者为R1或R2切除）。81例患者（78%）仅接受了挽救性近距离放射治疗，中位总剂量为56.7 Gy。104例患者中有23例（32%）接受了挽救性近距离放射治疗联合外照射放疗（EBRT），中位总剂量DREF = 24 Gy。在进行PDR近距离放射治疗的同时，104例患者中有58例（55.8%）接受了同步化疗。104例患者中有33例（31.7%）还接受了单次组织间热疗。在中位随访60个月后进行分析。
根据Kaplan-Meier法计算，2年、5年和10年的局部肿瘤控制率分别为92.5%、82.4%和58.9%。比较接受或未接受同步化疗的挽救性PDR近距离放射治疗的结果，10年局部控制率分别为76%和39%（p = 0.014）。没有其他患者或治疗相关参数对治疗结果有显著影响。分别有18/104（17.3%）和11/104（9.6%）的患者发生了软组织坏死或骨坏死，但仅3%的患者需要手术治疗。
PDR组织间近距离放射治疗联合同步化疗是一种非常有效的治疗方式，在经验丰富的医生手中，对于先前接受过放疗的部分头颈部癌患者也是一种安全的治疗方式。
