Pernot M, Hoffstetter S, Peiffert D, Luporsi E, Marchal C, Kozminski P, Dartois D, Bey P
Centre Alexis Vautrin, Vandoeuvre les Nancy, France.
Radiother Oncol. 1995 Jun;35(3):177-85. doi: 10.1016/0167-8140(95)01564-w.
Our aim was to study the results and the complications of this series of 207 patients treated from 1976 to 1992 and to compare them with the results of the literature.
The treatment consisted of a combination of external beam irradiation (EBI) (to the tumor and the node areas) and complementary brachytherapy to the primary tumor in 105 cases. In 102 cases, brachytherapy only was delivered to the tumor with or without neck dissection of the node areas. The brachytherapy was performed mostly with the hairpin technique in the beginning (in 61 cases) and subsequently the plastic tube technique with iridium wires. The dosimetry followed the Paris system rules. There were 41% T1, 48% T2, 8% T3, 2% T4 and 1% Tx with 83% N0, 12% N1, 3% N2, 2% N3. Ninety-one percent of patients were male and 9% were female.
The local control at 5 years is 97, 72 and 51%, respectively, for T1, T2, T3. The specific survival (without the patients dead of intercurrent disease or second cancer) was 88, 47 and 36%, and the overall survival at 5 years was 71, 42 and 35%. Of note, approximately one third of patients died of intercurrent disease or second cancers (70 patients = 34%). Significant factors that can influence the results are: for local control, the size of the lesion T1/T2/T3 (p < 0.0001); for the locoregional control, the absence of node involvement. The following factors are not significant: age and sex (age significant for survival). The significant treatment factors are the safety margin (p < 0.0003), brachytherapy only on T for T2N0 (p = 0.01). A total duration of treatment of less than 50 days is also significant. The spacing and the total dose (higher dose for large tumors) were not found to be significant. The complications were classified into four grades: grade 1, 17% (median healing, 2 months for soft tissue complications and 5 months for bone complications); grade 2, 12%; grade 3, 6% (frequently requiring surgical resection); grade 4, 0.5% (death, one case). In this series, for the complications, the dose rate, the spacing and the total dose were found not to be significant.
Carcinomas of the floor of mouth treated by exclusive irradiation have a rather good prognosis and the number of grade 2 and 3 complications remains acceptable. Exclusive brachytherapy is preferable to the combination of EBI plus brachytherapy for T1T2N0.
我们旨在研究1976年至1992年期间接受治疗的这207例患者的治疗结果及并发症，并将其与文献报道的结果进行比较。
105例患者的治疗包括外照射（针对肿瘤及淋巴结区域）联合针对原发肿瘤的补充近距离放疗。102例患者仅接受针对肿瘤的近距离放疗，部分患者同时或不同时进行颈部淋巴结清扫。近距离放疗起初大多采用发夹技术（61例），随后采用带铱丝的塑料管技术。剂量测定遵循巴黎系统规则。患者中T1占41%，T2占48%，T3占8%，T4占2%，Tx占1%；N0占83%，N1占12%，N2占3%，N3占2%。91%为男性，9%为女性。
T1、T2、T3患者5年局部控制率分别为97%、72%和51%。特异性生存率（不包括死于并发疾病或第二原发癌的患者）分别为88%、47%和36%，5年总生存率分别为71%、42%和35%。值得注意的是，约三分之一的患者死于并发疾病或第二原发癌（70例，占34%）。影响治疗结果的显著因素为：对于局部控制，病变大小T1/T2/T3（p<0.0001）；对于区域控制，有无淋巴结受累。以下因素不显著：年龄和性别（年龄对生存率有显著影响）。显著的治疗因素为安全边界（p<0.0003）、T2N0患者仅行近距离放疗（p = 0.01）。治疗总时长少于50天也具有显著性。未发现间隔及总剂量（大肿瘤给予更高剂量）具有显著性。并发症分为四级：1级，17%（软组织并发症中位愈合时间为2个月，骨并发症为5个月）；2级，12%；3级，6%（常需手术切除）；4级，0.5%（死亡1例）。在本系列研究中，对于并发症，未发现剂量率、间隔及总剂量具有显著性。
单纯放疗治疗口底癌预后较好，2级和3级并发症数量仍可接受。对于T1T2N0患者，单纯近距离放疗优于外照射联合近距离放疗。
