Pernot M, Aletti P, Carolus J M, Marquis I, Hoffstetter S, Maaloul F, Peiffert D, Lapeyre M, Luporsi E, Marchal C
Centre Alexis Vautrin, Vandoeuvre les Nancy, France.
Radiother Oncol. 1995 Jun;35(3):186-92. doi: 10.1016/0167-8140(95)01557-w.
PURPOSE/OBJECTIVE: We tried to reduce the number of local recurrences after surgery and external beam irradiation (EBI) in carcinoma of the oral cavity, when margins were positive or close.
From 1980 to 1992, we treated 97 cases of carcinomas of the oral cavity by postoperative brachytherapy. Surgery was combined with EBI+brachytherapy in 51 cases and with brachytherapy alone in 46 cases. We treated 29 T1, 34 T2, 30 T3T4 and four Tx (73% were N0 at first examination and 23% had positive nodes). The type of surgery is analysed. Brachytherapy was performed in one or two planes along the surgical scar. If the mandibular rim was resected, especially when the tongue or the remaining floor were sutured to the internal face of the inferior lip or to the buccal mucosa, the bridge technique was used. To decrease the dose to the inferior part of the mandible, the bridge was modified thanks to experimental dosimetry.
At 5 years, the local control (LC) is 89%, the locoregional control (LRC) 82%, the specific survival (SS) 74% and the overall survival (OS) 67%.
We noted 19% of grade 1 (minor), 12% of grade 2 (moderate) and 6% of grade 3 (major) complications.
Compared with the results of the literature, we think that postoperative brachytherapy can improve classical radiosurgical results in selected cases with a risk of local recurrence.
当口腔癌手术切缘阳性或接近阳性时，我们试图减少术后局部复发的数量。
1980年至1992年，我们对97例口腔癌患者进行了术后近距离放疗。51例患者接受了手术联合外照射放疗（EBI）加近距离放疗，46例患者仅接受近距离放疗。我们治疗了29例T1期、34例T2期、30例T3/T4期和4例Tx期患者（初诊时73%为N0，23%有阳性淋巴结）。分析了手术类型。沿手术切口在一个或两个平面进行近距离放疗。如果下颌骨边缘被切除，特别是当舌或剩余的口底缝合到下唇内面或颊黏膜时，采用桥接技术。为了减少下颌骨下部的剂量，根据实验剂量学对桥接技术进行了改进。
5年时，局部控制率（LC）为89%，区域控制率（LRC）为82%，特异性生存率（SS）为74%，总生存率（OS）为67%。
我们注意到19%为1级（轻度）并发症，12%为2级（中度）并发症，6%为3级（重度）并发症。
与文献结果相比，我们认为术后近距离放疗可以改善某些有局部复发风险的特定病例的传统放疗手术结果。
