Langlois D, Hoffstetter S, Pernot M
Department of Brachytherapy, Centre Alexis Vautrin, Vandoeuvre les Nancy, France.
Acta Oncol. 1988;27(5):571-3. doi: 10.3109/02841868809093590.
Between 1972 and 1984, 123 patients with recurrent or new primary carcinomas in previously irradiated areas of soft palate, tonsil, base of tongue or mobile tongue were re-irradiated with iridium-192 afterloading techniques. The average re-irradiation dose was 62 Gy (31-84 Gy) and the total dose 131 Gy (92-162 Gy); only 28 cases of mucosal necrosis were observed (23%). Two and 5 years actuarial local control rates were 67% and 59% and survival rates 48% and 24% respectively. Death was related to local tumor in 48 cases, metastases in 8 cases and intercurrent disease in 39 cases. We analyzed the effect on survival and local control of age, initial tumor site and volume, previous surgery, time between first irradiation and re-irradiation, doses, dose rate, and techniques of brachytherapy. With this analysis as background, we recommend the use of salvage brachytherapy for patients with a) small tumors of soft palate, tonsil or mobile tongue without synchronic lymph node metastases, b) long time interval between first irradiation and re-irradiation, c) new primary tumors (rather than recurrence of first tumor), and d) no previous local surgery. A high re-irradiation dose given with low dose rate is recommended.
1972年至1984年间，123例软腭、扁桃体、舌根或活动舌先前照射部位出现复发性或新发原发性癌的患者，采用铱-192后装技术进行了再照射。再照射平均剂量为62 Gy（31 - 84 Gy），总剂量为131 Gy（92 - 162 Gy）；仅观察到28例黏膜坏死（23%）。2年和5年精算局部控制率分别为67%和59%，生存率分别为48%和24%。死亡原因与局部肿瘤相关的有48例，与转移相关的有8例，与并发疾病相关的有39例。我们分析了年龄、初始肿瘤部位和体积、既往手术情况、首次照射与再照射之间的时间间隔、剂量、剂量率以及近距离放疗技术对生存和局部控制的影响。以此分析为背景，我们建议对以下患者使用挽救性近距离放疗：a）软腭、扁桃体或活动舌的小肿瘤且无同步淋巴结转移；b）首次照射与再照射之间时间间隔长；c）新发原发性肿瘤（而非首次肿瘤复发）；d）既往无局部手术史。建议采用低剂量率给予高再照射剂量。
