Toita T, Nakano M, Takizawa Y, Sueyama H, Kakihana Y, Kushi A, Ogawa K, Hara R, Sunakawa H, Arasaki A
Department of Radiology, University of the Ryukyus School of Medicine, Okinawa, Japan.
Int J Radiat Oncol Biol Phys. 1994 Dec 1;30(5):1219-24. doi: 10.1016/0360-3016(94)90332-8.
To determine the efficacy of intraoperative radiation therapy (IORT) for patients with advanced or recurrent head and neck cancer.
Intraoperative radiation therapy was given at 30 sites in 25 patients using a 6-18 MeV electron beam with or without conventional external beam irradiation. A single dose of 10-30 Gy was delivered after surgical resection. Sites treated with IORT were classified into three types after surgical resection: gross residual disease (GR, n = 7), microscopic residual disease (MR, n = 12), and close margin (CM, n = 11). Local control rate, patterns of recurrence, survival rate, and complications were analyzed.
The 2-year cumulative local control rate within the IORT port was 54.1% for all cases, 0% for GR, 54.5% for MR, and 81.8% for CM. There were significant differences between GR and MR (p < 0.05), and GR and CM (p < 0.01). The majority of the failures inside the IORT port were associated with recurrence outside the port. Distant metastases occurred in five patients. Four of these had GR. The 2-year cumulative survival rate was 45.1% for all, 0% for GR, 33.0% for MR, and 70.0% for CM. Five patients (22%) experienced late complications. The 2-year cumulative complication rate was 32.8%. Four sites developed osteoradionecrosis and three developed carotid artery blowout. Incidence of complications increased when patients received over 20 Gy with a single dose of IORT.
Considering both therapeutic ratio and patterns of failure, it is not suitable to treat patients with gross residual disease with IORT. We could not firmly determine the therapeutic value of IORT for patients with microscopic residual disease and close margin. For this subset, further study of moderate dose (less than 20 Gy) IORT combined with adequate postoperative irradiation is needed.
确定术中放射治疗（IORT）对晚期或复发性头颈癌患者的疗效。
25例患者的30个部位接受了术中放射治疗，使用6-18 MeV电子束，联合或不联合传统外照射。手术切除后给予单次剂量10-30 Gy。IORT治疗的部位在手术切除后分为三种类型：大体残留病灶（GR，n = 7）、镜下残留病灶（MR，n = 12）和切缘接近（CM，n = 11）。分析局部控制率、复发模式、生存率和并发症。
所有病例IORT照射野内2年累积局部控制率为54.1%，GR为0%，MR为54.5%，CM为81.8%。GR与MR（p < 0.05）以及GR与CM（p < 0.01）之间存在显著差异。IORT照射野内的大多数失败与照射野外复发有关。5例患者发生远处转移。其中4例为GR。所有患者2年累积生存率为45.1%，GR为0%，MR为33.0%，CM为70.0%。5例患者（22%）出现晚期并发症。2年累积并发症发生率为32.8%。4个部位发生放射性骨坏死，3个部位发生颈动脉破裂。当患者单次IORT剂量超过20 Gy时，并发症发生率增加。
综合考虑治疗比和失败模式，IORT不适合治疗有大体残留病灶的患者。我们不能确定IORT对镜下残留病灶和切缘接近患者的治疗价值。对于这一亚组患者，需要进一步研究中等剂量（小于20 Gy）IORT联合适当术后放疗。
