Murakami Naoya, Yoshimoto Seiichi, Uematsu Masakazu, Kashihara Tairo, Takahashi Kana, Inaba Koji, Okuma Kae, Igaki Hiroshi, Nakayama Yuko, Masui Koji, Yoshida Ken, Itami Jun
Department of Radiation Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, Japan.
Department of Head and Neck Surgery, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, Japan.
BJR Case Rep. 2020 Aug 21;6(4):20200005. doi: 10.1259/bjrcr.20200005. eCollection 2020 Dec 1.
High-dose-rate interstitial brachytherapy (HDR-ISBT) is relatively rarely applied for the head and neck cancer because of its anatomical complexity and difficulty of applicator placement. However, its dose distribution is more confined even better than intensity-modulated radiation therapy (IMRT) and can deliver a higher dose while sparing surrounding normal tissues. In this case report, the effectiveness of HDR-ISBT as a boost following IMRT for keratinizing squamous cell carcinoma of nasopharynx was presented. A 76-year-old female who suffered from cT3N0M0 keratinizing squamous cell carcinoma of the nasopharynx was treated with definitive concurrent chemoradiation therapy involving IMRT. However, physical examination and laryngoscope fibre finding showed evident residual tumour at 60 Gy of IMRT, then, boost HDR-ISBT was proposed. After delivering 66 Gy of IMRT, CT image-guided HDR-ISBT 4 Gy in a single fraction was performed under local anaesthesia and sedation. MRI taken 5 months after HDR-ISBT showed remarkable shrinkage of the primary tumour. After HDR-ISBT, the remaining session of IMRT was delivered from the next day until 70 Gy in 35 fractions. It was demonstrated that boost HDR-ISBT combined with IMRT for keratinizing squamous cell carcinoma of the nasopharynx was performed safely and showed favourable efficacy.
高剂量率组织间近距离放射治疗（HDR-ISBT）因头颈部解剖结构复杂且施源器放置困难，在头颈部癌治疗中应用相对较少。然而，其剂量分布更局限，甚至优于调强放射治疗（IMRT），能在保护周围正常组织的同时给予更高剂量。本病例报告展示了HDR-ISBT作为IMRT后补充放疗用于鼻咽角化性鳞状细胞癌的有效性。一名76岁女性患有鼻咽cT3N0M0角化性鳞状细胞癌，接受了包括IMRT的根治性同步放化疗。然而，体格检查和纤维喉镜检查发现，在IMRT剂量达60 Gy时仍有明显残留肿瘤，于是建议采用补充HDR-ISBT。在给予6 Gy的IMRT后，在局部麻醉和镇静下，在CT图像引导下进行单次分割4 Gy的HDR-ISBT。HDR-ISBT后5个月的MRI显示原发肿瘤明显缩小。HDR-ISBT后，从次日起继续进行IMRT，直至35次分割达70 Gy。结果表明，补充HDR-ISBT联合IMRT用于鼻咽角化性鳞状细胞癌的治疗安全且疗效良好。
