头颈部癌的间质高剂量率近距离再照射治疗。
Head and neck cancer reirradiation with interstitial high-dose-rate brachytherapy.
作者信息
Hegde John V, Demanes D Jeffrey, Veruttipong Darlene, Chin Robert K, Park Sang-June, Kamrava Mitchell
机构信息
Department of Radiation Oncology, UCLA Medical Center, University of California, Los Angeles, Los Angeles, California.
Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, California.
出版信息
Head Neck. 2018 Jul;40(7):1524-1533. doi: 10.1002/hed.25137. Epub 2018 Mar 23.
BACKGROUND
As high-dose-rate (HDR) brachytherapy can preferentially spare normal anatomic structures surrounding the radiation target, we report on our experience using this technique in head and neck cancer reirradiation.
METHODS
Twenty patients received HDR brachytherapy reirradiation with curative or palliative intent from 2010-2015. Clinical and toxicity outcomes were recorded. Actuarial outcomes were calculated using Kaplan-Meier analysis.
RESULTS
For curative treatment, actuarial 2-year rates of local control and overall survival (OS) were 73% and 56%, respectively. Palliatively, a 6-month local control rate of 65% was seen. Age >70 years was associated with poorer OS (P = .042). Prior salvage resection showed a trend toward improved local control and OS (P = .069 and P = .063, respectively). Thirty-three percent had grade 3 to 4 late toxicities.
CONCLUSION
Curative-intent HDR brachytherapy reirradiation can provide excellent local control and encouraging OS. Given the late toxicity rates, patient selection is essential, with particular utility for younger patients or those treated with salvage resection.
背景
由于高剂量率（HDR）近距离放射治疗能够优先保护放射靶区周围的正常解剖结构，我们报告了我们在头颈部癌再程放疗中使用该技术的经验。
方法
2010年至2015年期间，20例患者接受了具有根治性或姑息性意图的HDR近距离放射治疗再程放疗。记录临床和毒性结果。使用Kaplan-Meier分析计算精算结果。
结果
对于根治性治疗，精算2年局部控制率和总生存率（OS）分别为73%和56%。姑息性治疗方面，6个月局部控制率为65%。年龄>70岁与较差的OS相关（P = 0.042）。先前的挽救性切除显示出局部控制和OS改善的趋势（分别为P = 0.069和P = 0.063）。33%的患者出现3至4级晚期毒性反应。
结论
具有根治性意图的HDR近距离放射治疗再程放疗能够提供出色的局部控制和令人鼓舞的OS。鉴于晚期毒性率，患者选择至关重要，对年轻患者或接受挽救性切除的患者尤为适用。
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