Crook J, Mazeron J J, Marinello G, Martin M, Raynal M, Calitchi E, Faraldi M, Ganem G, Le Bourgeois J P, Pierquin B
Département de cancérologie, Hôpital Henri Mondor, Créteil, France.
Int J Radiat Oncol Biol Phys. 1988 Jul;15(1):105-14. doi: 10.1016/0360-3016(88)90353-7.
Forty-eight patients with T1 or T2 epidermoid carcinomas of the base of tongue were treated at the Henri Mondor Hospital between 1971 and 1981. Forty-one patients received moderate dose 60Co external beam irradiation (mean: 48.6 Gy) to the primary tumor and regional nodes, followed by an interstitial iridium 192 implant to the primary tumor (mean: 32 Gy). This completed the treatment for the 30 node negative patients, but those with clinically positive nodes were managed by either an additional electron beam boost to the involved nodes or a neck dissection. Seven tumors were treated exclusively by implantation to the base of tongue (mean: 63 Gy). Five-year crude disease-free survival is 50% with 35% of patients dying of recurrent disease. Definitive local control for T1 lesions is 85% (11/13) and for T2 is 71% (25/35). A dose response effect was observed with local control of 79% (26/33) obtained with a combined dose greater than or equal to 75 Gy, but only 50% (4/8) for less than or equal to 70 Gy. For N0 patients definitive regional control is 97% and for N1-3 is 89%. Minor or moderate soft tissue ulceration was observed in 12 patients, including 3 cases that progressed to osteonecrosis. None required surgical intervention. No correlation exists between necrosis and tumor size or total dose.
1971年至1981年间，48例舌根部T1或T2期表皮样癌患者在亨利·蒙多医院接受了治疗。41例患者接受了中等剂量的60钴外照射（平均：48.6 Gy），照射部位为原发肿瘤和区域淋巴结，随后对原发肿瘤进行铱192组织间植入（平均：32 Gy）。这完成了30例淋巴结阴性患者的治疗，但临床淋巴结阳性的患者则通过对受累淋巴结追加电子束照射或进行颈部清扫来处理。7例肿瘤仅通过舌根部植入进行治疗（平均：63 Gy）。5年粗无病生存率为50%，35%的患者死于疾病复发。T1期病变的局部根治率为85%（11/13），T2期为71%（25/35）。观察到剂量反应效应，联合剂量大于或等于75 Gy时局部控制率为79%（26/33），但小于或等于70 Gy时仅为50%（4/8）。对于N0患者，区域根治率为97%，对于N1 - 3患者为89%。12例患者出现轻度或中度软组织溃疡，其中3例进展为骨坏死。均无需手术干预。坏死与肿瘤大小或总剂量之间无相关性。
