Bhalavat Rajendra, Chandra Manish, Pareek Vibhay, Nellore Lalitha, George Karishma, Nandakumar P, Bauskar Pratibha
Radiation Oncology Department, Jupiter Hospital, Thane (West).
Radiation Physics Department, Jupiter Hospital, Thane (West), India.
J Contemp Brachytherapy. 2017 Apr;9(2):124-131. doi: 10.5114/jcb.2017.67147. Epub 2017 Apr 13.
To evaluate the treatment outcomes with high-dose-rate (HDR) interstitial brachytherapy (HDR-BRT) in head and neck cancers (HNC).
Fifty-eight patients with HNC as per American Joint Committee on Cancer (AJCC) TNM staging criteria were analyzed retrospectively between 2008 and 2015. Forty-two patients received external beam radiotherapy (EBRT) with HDR-BRT and 16 patients received BRT alone. The survival was calculated with respect to median biological equivalent doses (BED) and median 2 Gy equivalent dose (EQD), keeping α/β = 10 for tumor. Loco-regional control and disease free survival was assessed.
The median follow-up period was 25 months (2-84 months). The disease-free survival (DFS) probability at year 1 was 82.7%, and 68% at year 7. The overall survival probability was 91.3% at year 1 and 85.8% at year 7. The local control rate was 70%. The rate of recurrence was 30%. Distant metastasis rate was 17.2%. The median BED and EQD, respectively, were 86.78 Gy and 71.6 Gy. The DFS was 74.1% and 75.9% in patients receiving a dose more than median BED and EQD, respectively, and was 64.8% and 61.5% for less than the median dose.
The overall outcome was good with implementation of HDR-BRT used alone or as boost, and shows DFS as better when the dose received is more than the median BED and median EQD. The role of HDR-BRT in HNC is a proven, effective, and safe treatment method with excellent long term outcome as seen in this study, which reflects the need for reviving the forgotten art and science of interstitial brachytherapy in HNC.
评估高剂量率（HDR）组织间近距离放射治疗（HDR-BRT）对头颈部癌（HNC）的治疗效果。
回顾性分析2008年至2015年间按照美国癌症联合委员会（AJCC）TNM分期标准确诊的58例HNC患者。42例患者接受了外照射放疗（EBRT）联合HDR-BRT，16例患者仅接受了BRT。根据肿瘤的α/β = 10，计算中位生物等效剂量（BED）和中位2 Gy等效剂量（EQD）的生存率。评估局部区域控制率和无病生存率。
中位随访期为25个月（2 - 84个月）。1年时无病生存率（DFS）概率为82.7%，7年时为68%。1年时总生存率概率为91.3%，7年时为85.8%。局部控制率为70%。复发率为30%。远处转移率为17.2%。中位BED和EQD分别为86.78 Gy和71.6 Gy。接受剂量超过中位BED和EQD的患者DFS分别为74.1%和75.9%，接受剂量低于中位剂量的患者DFS分别为64.8%和61.5%。
单独使用或作为增强治疗实施HDR-BRT的总体效果良好，并且当接受的剂量超过中位BED和中位EQD时，DFS更佳。如本研究所示，HDR-BRT在HNC中的作用是一种经过验证的、有效且安全的治疗方法，具有出色的长期效果，这反映了对头颈部癌中被遗忘的组织间近距离放射治疗技术和科学进行复兴的必要性。
