Pernot M, Malissard L, Hoffstetter S, Luporsi E, Peiffert D, Aletti P, Kozminski P, Bey P
Department of Brachytherapy, Centre Alexis Vautrin, Vandoeuvre-les-Nancy, France.
Int J Radiat Oncol Biol Phys. 1994 Jul 1;29(4):673-9. doi: 10.1016/0360-3016(94)90553-3.
Our aim was to study the different factors that influence the results and complications in a series of 448 carcinomas of the oral tongue treated from January 31, 1972 to December 31, 1986, by brachytherapy (Br) +/- neck dissection (181 cases) or combination of external beam irradiation and brachytherapy (EBI + Br) (267 cases).
The patients distribution (TNM classification 1979) was: 125 T1, 186 T2, 128 T3, 9 T4Tx, 78% N0, and 22% N+. We used guide gutter or plastic tubes technique (Paris system dosimetry). Results at 5 and 10 years are: local control 68% and 64%, locoregional control 58% and 53%, specific survival 45% and 39%, and overall survival 44% and 27%.
In the univariate analysis for local control (LC) and overall survival (OS), we considered the tumoral factors. At 5 years, the LC for T1, T2, T3 are 93%, 65%, and 49%, and the OS 69%, 41%, and 25%, respectively (p < 0.002). The lesions of the undersurface of the tongue have a better LC (77%) than other localizations (64%) (p = 0.02). For general factors, the index of general health condition, age, and sex were not significant for LC, but proved significant for OS (p = 0.01). Significant radiobiological factors: the safety margin (expressed by the ratio treated surface on tumoral surface > or = 1.2) is significant for LC and OS. This is the same if the interval between EBI and Br is < or = 20 days. Neither the dose rate, the spacing between the sources, the total dose, nor Br dose were significant, but the last two were adapted according to the infiltration. In the univariate study for grade 2 and 3 complications (tissue and bone), the surface treated (> 12 cm2), and the dose rate > 0.7 Gy/h were significant.
The multivariate study showed that the small size of the lesion is the most important factor for local control, with brachytherapy alone for T1T2N0 and the number of days between EBI and brachytherapy < or = 20 days. For the complications, the most important factors are the total dose > 80 Gy and a treated surface > 12 cm2.
我们的目的是研究一系列448例舌癌的不同影响因素，这些舌癌于1972年1月31日至1986年12月31日接受近距离放射治疗（Br）±颈部清扫术（181例）或外照射与近距离放射治疗联合（EBI + Br）（267例）。
患者分布（1979年TNM分类）为：125例T1期、186例T2期、128例T3期、9例T4Tx期，78%为N0，22%为N + 。我们采用引导槽或塑料管技术（巴黎系统剂量测定法）。5年和10年的结果为：局部控制率分别为68%和64%，区域控制率分别为58%和53%，特异性生存率分别为45%和39%，总生存率分别为44%和27%。
在局部控制（LC）和总生存（OS）的单因素分析中，我们考虑了肿瘤因素。5年时，T1、T2、T3期的LC分别为93%、65%和49%，OS分别为69%、41%和25%（p < 0.002）。舌腹面的病变比其他部位具有更好的LC（77%）（p = 0.02）。对于一般因素，一般健康状况指数、年龄和性别对LC无显著影响，但对OS有显著影响（p = 0.01）。重要的放射生物学因素：安全边界（以治疗面积与肿瘤面积之比>或 = 1.2表示）对LC和OS有显著影响。如果EBI与Br之间的间隔<或 = 20天，情况相同。剂量率、源间间距、总剂量和Br剂量均无显著影响，但后两者根据浸润情况进行调整。在2级和3级并发症（组织和骨）的单因素研究中，治疗面积（> 12 cm²）和剂量率> 0.7 Gy/h有显著影响。
多因素研究表明，病变体积小是局部控制的最重要因素，对于T1T2N0期单独采用近距离放射治疗，以及EBI与近距离放射治疗之间的天数<或 = 20天。对于并发症，最重要的因素是总剂量> 80 Gy和治疗面积> 12 cm²。
