Rafla S, Parikh K, Tchelebi M, Youssef E, Selim H, Bishay S
Radiation Oncology Department, Methodist Hospital, Brooklyn, NY 11215.
Radiology. 1989 Sep;172(3):845-50. doi: 10.1148/radiology.172.3.2772199.
Cancer that recurs after surgery and radiation therapy remains a major problem. The claimed effectiveness of thermobrachytherapy in patients with this problem prompted the present study. Forty-six lesions (20 head and neck, 18 pelvic, seven chest wall, and one limb sarcoma) in 38 patients were treated with interstitial hyperthermia that sandwiched the use of Ir-192 with the aim of delivering 2,000-6,000 cGy, depending on prior dose and tissue tolerance. Complete regression occurred in 19 (54%) of 35 evaluable cases. More than 58,000 measured temperature points were analyzed to develop a representative quantitative measure, the "modal thermal dose," that represented the temperature reported most often during heating sessions. The pattern was plotted in each case. No significant relation was found between heating patterns and tumor response. Of all the prognostic factors studied, the radiation dose was the most significant, with a complete response rate being 78% when the total radiation dose exceeded 6,000 cGy, compared with 8% when the dose was lower than 5,000 cGy (P less than .005). The tumor volume also was important, with smaller lesions responding much better than larger ones (P = .1).
手术后复发且接受过放射治疗的癌症仍然是一个主要问题。热近距离放射疗法对这类患者宣称的有效性促使了本研究的开展。38例患者的46个病灶（20个头颈病灶、18个盆腔病灶、7个胸壁病灶和1个肢体肉瘤病灶）接受了间质热疗，该热疗采用Ir - 192并根据先前剂量和组织耐受性，目标是给予2000 - 6000 cGy的剂量。35例可评估病例中有19例（54%）完全消退。对超过58000个测量温度点进行分析以制定一种代表性的定量指标，即“模式热剂量”，它代表加热过程中报告频率最高的温度。在每个病例中绘制了温度模式图。未发现加热模式与肿瘤反应之间存在显著关系。在所有研究的预后因素中，放射剂量最为显著，当总放射剂量超过6000 cGy时，完全缓解率为78%，而当剂量低于5000 cGy时，完全缓解率为8%（P小于0.005）。肿瘤体积也很重要，较小的病灶比较大的病灶反应要好得多（P = 0.1）。
