Fongione S, Signor M, Beorchia A
Istituto di Radioterapia Oncologica, Ospedale Civile, Udine.
Radiol Med. 1994 Nov;88(5):657-60.
Squamous cell carcinomas of the lip can be treated by surgery or radiation therapy. Since local control rates exceed 90% with both treatment modalities, therapy is chosen according to functional and cosmetic results, to the patient's wishes and to the physician's medical policy. This study was aimed at retrospectively reviewing our local control results and patterns of failure relative to survival as well as evaluating the results according to technical surgical variables. From 1982 to 1991, sixty-nine patients with squamous cell carcinoma of the lip received a course of interstitial brachytherapy with 192Ir. The disease stage was T1 in 36 cases, T2 in 12 cases and T3 in 2 cases and 19 recurrences; 3 patients only had clinically detectable lymph nodes at diagnosis. Interstitial brachytherapy was used as postoperative treatment, at a dose of 60 Gy, in 47 cases. As an exclusive curative approach brachytherapy was given at a reference dose of 65 Gy, with a medium dose rate of 62.88 cGy; a single plane was used in 55 cases, a triangular plane in 11 and a double plane in 3 cases. In one patient only the disease persisted and no local failures were observed. Overall actuarial survival at 5 years is 76.81% (91.3% when corrected for disease). In fact, 6 patients died of disease progression: 3 with lung metastases, 1 with bone metastases and 3 with lymph node metastases. Five patients died of cancer in other sites--i.e., ovary, lung, prostate, hypopharynx, stomach--and 4 of non-neoplastic diseases. Tolerance rates were excellent, with only one mucosal necrosis which resolved spontaneously; no sequelae were observed in gums, teeth and jaws. The cosmetic result was also excellent in most of the cases with a worsening trend for multiplanar disposition. In conclusion, interstitial brachytherapy can be considered the treatment of choice for early lip cancer.
唇部鳞状细胞癌可通过手术或放射治疗。由于两种治疗方式的局部控制率均超过90%，因此根据功能和美容效果、患者意愿以及医生的医疗策略来选择治疗方法。本研究旨在回顾性分析我们的局部控制结果、相对于生存的失败模式，并根据手术技术变量评估结果。1982年至1991年，69例唇部鳞状细胞癌患者接受了192Ir组织间近距离放射治疗。疾病分期为T1期36例，T2期12例，T3期2例，有19例复发；3例患者在诊断时仅临床可检测到淋巴结。47例患者将组织间近距离放射治疗用作术后治疗，剂量为60 Gy。作为唯一的治愈方法，近距离放射治疗的参考剂量为65 Gy，平均剂量率为62.88 cGy；55例采用单平面，11例采用三角形平面，3例采用双平面。仅1例患者疾病持续存在，未观察到局部失败。5年总精算生存率为76.81%（校正疾病后为91.3%）。事实上，6例患者死于疾病进展：3例有肺转移，1例有骨转移，3例有淋巴结转移。5例患者死于其他部位的癌症，即卵巢、肺、前列腺、下咽、胃，4例死于非肿瘤性疾病。耐受性良好，仅1例黏膜坏死自发缓解；牙龈、牙齿和颌骨未观察到后遗症。大多数病例的美容效果也很好，多平面布局有恶化趋势。总之，组织间近距离放射治疗可被视为早期唇癌的首选治疗方法。
