Beauvois S, Hoffstetter S, Peiffert D, Luporsi E, Carolus J M, Dartois D, Pernot M
Radiotherapy Department, Institut Jules Bordet, Brussels, Belgium.
Radiother Oncol. 1994 Dec;33(3):195-203. doi: 10.1016/0167-8140(94)90354-9.
From 1972 to 1991, 237 patients with squamous cell carcinoma of the lower lip were treated by exclusive LDR brachytherapy (192Ir). There were 158 T1, 61 T2, 17 T3 and 1 T4 with 231 N0, 3 N1 and 3 N2 patients. The actuarial values at 5 years for local and regional controls, overall and specific survivals were 95%, 91%, 74% and 91%. Salvage treatment increased local control up to 99% and regional control to 94%. No heterolabial recurrence has been observed since the entire lip is treated, even for small tumors. The regional control depends closely on the thickness of the labial tumor (> or = 1 cm, p < 0.0001). The healing of treatment-induced mucositis is sometimes delayed for thick tumors (> or = 1 cm, p = 0.015). Late complications are not related to tumoral thickness but to the treated thickness (> 1.4 cm, p = 0.018) and particularly to the thickness of normal tissue included in the 85% isodose (treated thickness - tumoral thickness > 0.4 cm, p = 0.025). The use of a leaded protection and low linear radioactivity wires (< 2 mCi/cm, < 8.6 muGy/h.m2/cm) especially for large target volumes is required to lessen late complications. Based on this review, we advocate exclusive brachytherapy for small and intermediate tumors, with elective bilateral submaxillary and submental dissection for thick, high grade or commissure tumors. Simple recommendations are made to assure quality of the brachytherapy treatment.
1972年至1991年期间，237例下唇鳞状细胞癌患者接受了单纯近距离后装放疗（192铱）。其中T1期158例，T2期61例，T3期17例，T4期1例；N0期231例，N1期3例，N2期3例。5年时局部和区域控制、总生存率和特异性生存率的精算值分别为95%、91%、74%和91%。挽救性治疗使局部控制率提高到99%，区域控制率提高到94%。由于整个唇部都接受了治疗，即使是小肿瘤，也未观察到异侧唇复发。区域控制与唇部肿瘤厚度密切相关（≥1 cm，p<0.0001）。对于厚肿瘤（≥1 cm，p=0.015），治疗引起的粘膜炎愈合有时会延迟。晚期并发症与肿瘤厚度无关，而与治疗厚度有关（>1.4 cm，p=0.018），尤其与85%等剂量线所包含的正常组织厚度有关（治疗厚度-肿瘤厚度>0.4 cm，p=0.025）。为减少晚期并发症，对于大靶区尤其需要使用铅防护和低线性放射性导线（<2 mCi/cm，<8.6 μGy/h·m²/cm）。基于本综述，我们主张对小肿瘤和中等大小肿瘤采用单纯近距离放疗，对厚的、高级别或累及口角的肿瘤行选择性双侧颌下和颏下淋巴结清扫。还提出了一些简单建议以确保近距离放疗的质量。
