Mazeron J J, Marinello G, Crook J, Marin L, Mahot P, Raynal M, Calitchi E, Peynegre R, Ganem G, Faraldi M
Département de cancérologie, hopital Henri Mondor, Créteil, France.
Int J Radiat Oncol Biol Phys. 1987 Dec;13(12):1829-37. doi: 10.1016/0360-3016(87)90348-8.
From 1971 to 1984 59 T1 and T2 carcinomas of the soft palate and uvula were treated definitively by irradiation at the Henri Mondor hospital. Included are ten patients previously irradiated to the oropharyngeal area for either a carcinoma of the soft palate or another malignancy. Sixteen patients were treated by external irradiation alone, 14 by Iridium 192 implantation, and 29 by a combination of the two. Two techniques of implantation were used: the guide gutter technique (33 patients) and the plastic tube technique (10 patients). Clinically negative neck nodes (51/59) either received prophylactic telecobalt therapy (39/51) or were surveilled (12/51). Clinically involved nodes (8/59) were managed either by external irradiation alone (4/8) or combined with neck dissection (4/8). Local failure was 25% (4/16) after exclusive telecobalt therapy, 18% (5/19) after combined telecobalt therapy and implantation, and 0% (0/14) after Iridium 192 implantation alone. No local failures were seen with the plastic tube technique (0/10) as compared to 15% (5/33) for guide gutters. Only two nodal failures were observed (2/59: 3%). Crude 5-year disease-free survival was 33%. Severe complications were limited to one osteonecrosis, one soft tissue necrosis, and one partial palatal incompetence. Salivary impairment was reduced when implantation was used for part or all of the treatment. We recommend 45 Gy external radiation followed by 30 Gy from Iridium 192 implantation using the plastic tube method unless there has been prior oropharyngeal irradiation, in which case we give 60 Gy from implantation alone. For clinically negative neck nodes, we recommend 45 Gy prophylactic external neck irradiation. For clinically positive lymph nodes, this should be followed by either a 25 to 30 Gy boost to the involved nodes or a neck dissection.
1971年至1984年期间，59例软腭和悬雍垂的T1和T2期癌在亨利·蒙多医院接受了根治性放疗。其中包括10例先前因软腭癌或其他恶性肿瘤接受过口咽区域放疗的患者。16例患者仅接受外照射治疗，14例接受铱192植入治疗，29例接受两种方法联合治疗。采用了两种植入技术：导槽技术（33例患者）和塑料管技术（10例患者）。临床阴性颈部淋巴结（51/59）要么接受预防性远距离钴治疗（39/51），要么接受观察（12/51）。临床受累淋巴结（8/59）要么仅接受外照射治疗（4/8），要么联合颈部清扫术（4/8）。单纯远距离钴治疗后局部失败率为25%（4/16），远距离钴治疗与植入联合治疗后为18%（5/19），单纯铱192植入后为0%（0/14）。与导槽技术的15%（5/33）相比，塑料管技术未出现局部失败（0/10）。仅观察到两例淋巴结失败（2/59：3%）。5年粗无病生存率为33%。严重并发症仅限于1例骨坏死、1例软组织坏死和1例部分腭功能不全。当植入用于部分或全部治疗时，唾液功能损害有所减轻。我们建议先进行45 Gy的外照射，然后采用塑料管法进行30 Gy的铱192植入，除非之前接受过口咽放疗，在这种情况下，我们仅进行60 Gy的植入治疗。对于临床阴性颈部淋巴结，我们建议进行45 Gy的预防性颈部外照射。对于临床阳性淋巴结，应随后对受累淋巴结进行25至30 Gy的加量照射或进行颈部清扫术。
