Department of Radiation Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Parel, Mumbai, India.
Department of Radiation Oncology, Foundation Instituto Valenciano de Oncologia (I.V.O.), Valencia, Spain.
Clin Oncol (R Coll Radiol). 2023 Aug;35(8):497-506. doi: 10.1016/j.clon.2023.01.022. Epub 2023 Feb 6.
The treatment of head and neck cancers can have a significant impact on function and appearance, which results in impairment of quality of life. Various long-term sequelae of treatment include speech and swallowing difficulty, oral incompetence, trismus, xerostomia, dental caries and osteoradionecrosis. Management has evolved from single modality treatment of either surgery or radiation to multimodality treatment to attain acceptable functional outcomes. Brachytherapy, also known as interventional radiotherapy, with its ability to deliver high doses centrally to the target, has been shown to improve local control rates. Due to the rapid fall-off of the dose of brachytherapy there is better organ at risk sparing as compared with that of external beam radiotherapy. In the head and neck region, brachytherapy has been practiced in various sites, including the oral cavity, oropharynx, nasopharynx, nasal vestibule and paranasal sinuses. Additionally, brachytherapy has also been considered for reirradiation as a salvage. Brachytherapy can also be considered as a perioperative technique together with surgery. Close multidisciplinary cooperation is required for a successful brachytherapy programme. In oral cavity cancers, depending on the location of the tumour, brachytherapy has been shown to preserve oral competence, maintain tongue mobility, maintain speech, swallowing and the hard palate. Brachytherapy in oropharyngeal cancers has been shown to reduce xerostomia and also reduce dysphagia and aspiration post-radiation therapy. For the nasopharynx, paranasal sinus and nasal vestibule, brachytherapy preserves the respiratory function of the mucosa. Despite such an incomparable impact on function and organ preservation, brachytherapy is an underutilised technique for head and neck cancers. There is a strong need to improve brachytherapy utilisation in head and neck cancers.
头颈部癌症的治疗会对功能和外观产生重大影响，从而导致生活质量受损。治疗的各种长期后遗症包括言语和吞咽困难、口腔功能不全、牙关紧闭、口干、龋齿和放射性骨坏死。治疗方法已经从单一模式的手术或放疗发展为多模式治疗，以达到可接受的功能结果。近距离放射治疗，也称为介入放射治疗，因其能够在靶区中央提供高剂量，已被证明可提高局部控制率。由于近距离放射治疗的剂量迅速下降，与外照射相比，对器官的风险保护更好。在头颈部，近距离放射治疗已在多个部位进行，包括口腔、口咽、鼻咽、鼻前庭和副鼻窦。此外，近距离放射治疗也被认为是挽救性再放射治疗的一种选择。近距离放射治疗也可以作为手术的围手术期技术。成功的近距离放射治疗计划需要密切的多学科合作。在口腔癌中，根据肿瘤的位置，近距离放射治疗已被证明可以保持口腔功能，保持舌头的活动度，保持言语、吞咽和硬腭的功能。口咽癌的近距离放射治疗已被证明可以减少口干，并减少放疗后的吞咽困难和吸入。对于鼻咽、副鼻窦和鼻前庭，近距离放射治疗可以保持粘膜的呼吸功能。尽管近距离放射治疗对头颈部癌症的功能和器官保护有如此无与伦比的影响，但它仍是一种未充分利用的技术。强烈需要提高头颈部癌症中近距离放射治疗的利用率。
