Centre of Radiotherapy, National Institute of Oncology, Ráth György St. 7-9, 1122, Budapest, Hungary.
Department of Oncology, Semmelweis University, Budapest, Hungary.
Strahlenther Onkol. 2022 Sep;198(9):812-819. doi: 10.1007/s00066-022-01901-w. Epub 2022 Feb 14.
To describe the results of treating tongue cancer patients with single postoperative interstitial, high-dose-rate (HDR) brachytherapy (BT) after resection.
Between January 1998 and April 2019, 45 patients with squamous cell histology, stage T1-2N0-1M0 tongue tumours were treated by surgery followed by a single HDR BT in case of negative prognostic factors (close or positive surgical margin, lymphovascular and/or perineural invasion). The average dose was 29 Gy (range: 10-45 Gy) and rigid metal needles were used in 11 (24%) and flexible plastic catheters in 34 cases (76%). Survival parameters, toxicities and the prognostic factors influencing survival were analysed.
During a mean follow-up of 103 months (range: 16-260 months) for surviving patients, the 10-year local and regional control (LC, RC), overall survival (OS), and disease-specific survival (DSS) probabilities were 85, 73, 34 and 63%, respectively. The incidence of local grade 1, 2 and 3 mucositis was 23, 73 and 4%, respectively. As a serious (grade 4), late side effect, soft tissue necrosis developed in 3 cases (7%). In a univariate analysis, there was a significant correlation between lymphovascular invasion and RC (p = 0.0118) as well as cervical recurrence and DSS (p < 0.0001).
Sole postoperative HDR brachytherapy can be an effective method in case of negative prognostic factors in the treatment of early, resectable tongue tumours. Comparing the results of patients treated with postoperative BT to those who were managed with surgery or BT alone known from the literature, a slightly more favourable LC can be achieved with the combination therapy, demonstrating the potential compensating effect of BT on adverse prognostic factors, while the developing severe, grade 4 toxicity rate remains low.
描述切除术后采用单次术后间质内高剂量率（HDR）近距离放疗（BT）治疗舌癌患者的结果。
1998 年 1 月至 2019 年 4 月期间，45 例组织学为鳞状细胞癌、T1-2N0-1M0 期舌肿瘤患者接受手术治疗，如果存在预后不良因素（切缘接近或阳性、淋巴血管和/或神经周围侵犯），则采用单次 HDR BT。平均剂量为 29 Gy（范围：10-45 Gy），11 例（24%）采用刚性金属针，34 例（76%）采用柔性塑料导管。分析了生存患者的生存参数、毒性以及影响生存的预后因素。
在存活患者的平均随访 103 个月（范围：16-260 个月）期间，10 年局部和区域控制（LC、RC）、总生存率（OS）和疾病特异性生存率（DSS）分别为 85%、73%、34%和 63%。局部 1 级、2 级和 3 级黏膜炎的发生率分别为 23%、73%和 4%。3 例（7%）出现严重（4 级）迟发性副作用软组织坏死。单因素分析显示，淋巴血管侵犯与 RC 显著相关（p=0.0118），颈淋巴结复发与 DSS 显著相关（p<0.0001）。
在存在预后不良因素的情况下，单纯术后 HDR BT 可作为治疗早期可切除舌肿瘤的有效方法。与文献中已知的接受术后 BT 治疗的患者和单独接受手术或 BT 治疗的患者的结果相比，联合治疗可获得略高的 LC，表明 BT 对不良预后因素具有潜在的补偿作用，而严重 4 级毒性发生率仍然较低。
