Department of Radiation Oncology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China.
Radiat Oncol. 2023 May 3;18(1):73. doi: 10.1186/s13014-023-02254-z.
In the past, patients with recurrent head and neck cancer (rHNC) who had previously received a high dose of radiation and were unable to undergo surgery were mainly treated with palliative chemotherapy due to the high incidence of side effects from re-irradiation. With the development of radiotherapy technology, re-irradiation of recurrent lesions by radioactive iodine-125 seed implantation (RISI) has been proposed as a feasible therapeutic approach. This study aimed to investigate the safety and efficacy of computed tomography (CT)-guided RISI in the treatment of rHNC after two or more courses of radiotherapy, and to analyze the prognostic factors.
Data of 33 patients with rHNC who received CT-guided RISI after two or more courses of radiotherapy were collected and statistically analyzed. The median cumulative dose of the previous radiotherapy was 110 Gy. Short-term efficacy was assessed by Response Evaluation Criteria in Solid Tumors (version 1.1) criteria, while adverse events were evaluated by Common Terminology Criteria for Adverse Events (version 5.0) criteria.
The median gross tumor volume (GTV) was 29.5 cc, and the postoperative median dose to 90% of target volume (D90) was 136.8 Gy. For adverse reactions, enhanced pain was found in 3 (9.1%) patients, followed by grade 1 to 2 acute skin reactions in 3 (9.1%) patients, grade 2 to 3 late skin reactions in 2 (6.1%) patients, grade 1 to 2 early mucosal reactions in 4 (12.1%) patients, and mandibular osteonecrosis in 1 (3.0%) patient. Regarding the treatment efficacy, the 1- and 2-year local control (LC) rates were 47.8% and 36.4% (median LC time, 10 months), and the 1- and 2-year overall survival (OS) rates were 41.3% and 32.2% (median OS time, 8 months). The absence of adverse events was associated with better LC.
CT-guided RISI, as a salvage therapy, demonstrated acceptable safety and efficacy in the treatment of rHNC after two or more courses of radiotherapy.
This study was registered at Chinese Clinical Trial Register database (Registration No. ChiCTR2200063261 ) in September 2, 2022.
过去，对于先前接受过高剂量放疗且无法手术的复发性头颈部癌症（rHNC）患者，由于再放疗的副作用发生率较高，主要采用姑息性化疗治疗。随着放疗技术的发展，放射性碘-125 种子植入（RISI）再放疗复发性病变已被提出作为一种可行的治疗方法。本研究旨在探讨 CT 引导下 RISI 治疗两次或两次以上放疗后 rHNC 的安全性和疗效，并分析预后因素。
收集并统计分析了 33 例接受 CT 引导下 RISI 治疗的两次或两次以上放疗后 rHNC 患者的数据。先前放疗的中位累积剂量为 110Gy。采用实体瘤反应评价标准（版本 1.1）评估短期疗效，采用不良事件通用术语标准（版本 5.0）评估不良事件。
中位肿瘤总体积（GTV）为 29.5cc，术后目标体积 90%的中位剂量（D90）为 136.8Gy。对于不良反应，发现 3 例（9.1%）患者出现增强疼痛，3 例（9.1%）患者出现 1-2 级急性皮肤反应，2 例（6.1%）患者出现 2-3 级晚期皮肤反应，4 例（12.1%）患者出现 1-2 级早期黏膜反应，1 例（3.0%）患者出现下颌骨坏死。关于治疗效果，1 年和 2 年局部控制（LC）率分别为 47.8%和 36.4%（中位 LC 时间为 10 个月），1 年和 2 年总生存率（OS）率分别为 41.3%和 32.2%（中位 OS 时间为 8 个月）。无不良事件与更好的 LC 相关。
CT 引导下 RISI 作为一种挽救性治疗方法，在两次或两次以上放疗后 rHNC 的治疗中显示出可接受的安全性和疗效。
本研究于 2022 年 9 月 2 日在中国临床试验注册中心数据库（注册号：ChiCTR2200063261）注册。
