Cisek Paweł, Kieszko Dariusz, Brzozowska Anna, Kordzin'ska-Cisek Izabela, Mazurkiewicz Maria
Department of Brachytherapy, Lublin Region Cancer Center; Department of Oncology, Medical University of Lublin.
Department of Brachytherapy, Lublin Region Cancer Center.
J Contemp Brachytherapy. 2016 Dec;8(6):544-553. doi: 10.5114/jcb.2016.63364. Epub 2016 Nov 2.
The aim of the study was the evaluation of image guided transdermal application of interstitial brachytherapy in patients undergoing repeated irradiation for relapsed local tumor of the head and neck area.
The article describes transdermal application of interstitial high-dose-rate (HDR) brachytherapy in 4 patients treated due to relapsed local tumor in soft palate, submandibular area, laryngopharynx, as well as pterygoid muscles and maxillary sinus. The application was conducted under continuous computed tomography (CT)-image guidance (CT fluoroscopy). Patients qualified for this type of treatment had neoplastic lesions located deep under the skin surface. Because of their location, access to the lesions was limited, and the risk of damaging the adjacent tissues such as vessels and nerves was high. The following parameters have been evaluated: clinical response using RECIST 1.1, incidence of perisurgical complications using CTCAE 4.0 and the frequency of occurrence of radiotherapy related early morbidity using RTOG.
Various radiation schemes were used, from 3 to 5 fractions of 3.5-5 Gy. The median total dose (D) was 20.6 Gy. Biologic effective dose (BED) and equivalent 2 Gy (DEQ) median doses were 30.4 Gy and 25.3 Gy, respectively. In the follow-up period of 3-7 months (the median value of 3.5 months), 2 patients had partial regression of the disease and in 2 others the neoplastic process was stabilized. None of the patients had serious complications of treatment (of 3 degree or higher).
Computed tomography-image guided brachytherapy proved to be a safe method of treatment in patients with local relapse in sites, in which traditional visually controlled application was impossible due to risk of complications. Despite short observation period and small study group, it seems justified to conduct prospective studies for the evaluation of efficacy and safety of CT-image guided brachytherapy.
本研究旨在评估图像引导下间质近距离放射治疗在头颈部局部肿瘤复发患者重复放疗中的应用。
本文描述了4例因软腭、下颌下区、下咽以及翼状肌和上颌窦局部肿瘤复发而接受间质高剂量率（HDR）近距离放射治疗的患者的经皮应用情况。该应用在连续计算机断层扫描（CT）图像引导（CT透视）下进行。符合此类治疗条件的患者肿瘤病变位于皮肤表面以下深处。由于其位置关系，病变的暴露受限，且损伤相邻组织如血管和神经的风险很高。评估了以下参数：使用RECIST 1.1评估临床反应，使用CTCAE 4.0评估围手术期并发症发生率，使用RTOG评估放疗相关早期发病率的发生频率。
采用了多种放疗方案，3至5次分割，每次3.5 - 5 Gy。中位总剂量（D）为20.6 Gy。生物等效剂量（BED）和等效2 Gy（DEQ）中位剂量分别为30.4 Gy和25.3 Gy。在3至7个月的随访期（中位值为3.5个月）内，2例患者疾病部分缓解，另外2例患者肿瘤进程稳定。所有患者均未发生严重治疗并发症（3级或更高）。
计算机断层扫描图像引导下的近距离放射治疗被证明是一种安全的治疗方法，适用于因并发症风险而无法进行传统视觉控制应用的局部复发部位的患者。尽管观察期短且研究组规模小，但进行前瞻性研究以评估CT图像引导下近距离放射治疗的疗效和安全性似乎是合理的。
