Santos Miguel Angel, Guinot Jose Luis, Tortajada Maria Isabel, Santamaría Paula, Campo Valentin, Oliver Laura, Peña Marina, Arribas Leoncio
Department of Radiation Oncology, Fundación Instituto Valenciano de Oncología (IVO), Valencia, Spain.
Department of Radiation Oncology, Fundación Instituto Valenciano de Oncología (IVO), Valencia, Spain.
Brachytherapy. 2017 Nov-Dec;16(6):1213-1218. doi: 10.1016/j.brachy.2017.07.006. Epub 2017 Aug 12.
Locally advanced tongue carcinomas (LATCs) in inoperable lesions are managed with external beam radiation therapy (EBRT) and chemotherapy. In our institution, the boost to the gross tumor volume is delivered with high-dose-rate brachytherapy (HDR-BT) after EBRT. We review the outcome of these patients when HDR-BT is added as a boost.
From May 2000 to December 2014, a total of 24 patients with LATC, nonsurgical oral tongue, and base of tongue carcinomas were treated with EBRT and with interstitial plastic tubes for brachytherapy; median dose was 18-24 Gy in 6-8 fractions after 50-60 Gy of EBRT. Mean age was 60 years, 20 men and 4 women. The distribution by stages was 11 patients in Stage III and 13 patients in Stage IV. All cases but one received chemotherapy.
With a median followup of 44 months, local control (LC) rate at 4 years was 80% for the entire group, 78% in Stage III, and 90% in Stage IV. The cause-specific survival was 68% at 4 years; the regional control was 76%. Four patients developed distant metastasis with disease free from distant metastasis of 77% at 4 years. The overall survival was 68% at 4 years.
HDR-BT yields similar results to low dose rate in treatment of patients with LATC, with better results than those reported with exclusive EBRT. HDR-BT allows to increase the local dose, with good LC rates. In patients with large tumors requiring very mutilating surgery and patients who refuse surgery, EBRT with HDR-BT boost is a good option to increase the LC and cause-specific survival while keeping a better functional outcome.
无法手术切除的局部晚期舌癌（LATC）采用外照射放疗（EBRT）和化疗进行治疗。在我们机构，EBRT后采用高剂量率近距离放疗（HDR-BT）对大体肿瘤体积进行推量照射。我们回顾了添加HDR-BT作为推量照射时这些患者的治疗结果。
2000年5月至2014年12月，共有24例LATC、非手术治疗的口腔舌癌和舌根癌患者接受了EBRT，并使用间质塑料导管进行近距离放疗；EBRT 50-60 Gy后，中位剂量为18-24 Gy，分6-8次给予。平均年龄为60岁，男性20例，女性4例。按分期分布为Ⅲ期11例，Ⅳ期13例。除1例患者外，所有病例均接受了化疗。
中位随访44个月，全组4年局部控制（LC）率为80%，Ⅲ期为78%，Ⅳ期为90%。4年病因特异性生存率为68%；区域控制率为76%。4例患者发生远处转移，4年无远处转移生存率为77%。4年总生存率为68%。
HDR-BT在治疗LATC患者时产生的结果与低剂量率相似，比单纯EBRT报道的结果更好。HDR-BT能够提高局部剂量，具有良好的LC率。对于需要进行非常致残性手术的大肿瘤患者和拒绝手术的患者，EBRT联合HDR-BT推量照射是提高LC和病因特异性生存率同时保持更好功能结局的良好选择。
