Bachaud J M, Delannes M, Allouache N, Benchalal M, Alzieu C, David J M, Serrano E, Daly-Schveitzer N J
Department of Radiotherapy, Centre Claudius Regaud, Toulouse, France.
Radiother Oncol. 1994 Jun;31(3):199-206. doi: 10.1016/0167-8140(94)90424-3.
From 1977 to 1990, 94 evaluable patients were treated with iridium-192 implantation in the Centre Claudius Regaud for a Stage I (52 patients) or a Stage II (42 patients) squamous cell carcinoma of the mobile tongue and/or the floor of the mouth. Interstitial brachytherapy was associated with external irradiation in 68 patients (group 1; mean dose, 48 Gy for external irradiation, 26 Gy for brachytherapy) or was exclusive in 26 patients (group 2; mean dose, 66 Gy). The mean follow-up was 44 months. Eleven acute complications were noted during or immediately after the implant (1 lethal myocardial infarction, 6 hematomas of the tongue which spontaneously resolved, 3 local sepsis). The mean duration of the mucositis was 9 weeks (from 4 to 20 weeks). Ten patients (17%) experienced a late complication (8 in group 1, 2 in group 2): 3 bone necroses requiring hemimandibulectomy (1 post-operative death), 1 tongue necrosis treated by a transoral mucosal excision, 6 bone expositions which recovered after medical treatment. Local control rates for T1 and T2 tumors were 75% (39/52) and 51% (21/41), respectively. Sixteen patients (17%) presented a nodal relapse which was associated in 6 cases with a concomitant local relapse. The local control rate of T1 tumors was 64% (23/36) in group 1 versus 100% (16/16) in group 2 (p < 0.01). For T2 tumors, these figures were 45% (14/31) and 70% (7/10), respectively (p > 0.3). The influence of 13 parameters on the local control was studied in analysis. In the one model analysis, a cox regression tumor size was significantly predictive of actuarial local recurrence (p < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)
1977年至1990年期间，克劳迪乌斯·雷戈中心对94例可评估患者采用铱-192植入治疗活动期舌部和/或口底的I期（52例患者）或II期（42例患者）鳞状细胞癌。68例患者（第1组）采用间质近距离放疗联合外照射（外照射平均剂量48 Gy，近距离放疗平均剂量26 Gy），26例患者（第2组）仅采用间质近距离放疗（平均剂量66 Gy）。平均随访时间为44个月。植入期间或植入后立即出现11例急性并发症（1例致命性心肌梗死、6例舌部血肿自行消退、3例局部脓毒症）。黏膜炎的平均持续时间为9周（4至20周）。10例患者（17%）出现晚期并发症（第1组8例，第2组2例）：3例骨坏死需行半侧下颌骨切除术（1例术后死亡），1例舌坏死经经口黏膜切除术治疗，6例骨外露经药物治疗后恢复。T1和T2肿瘤的局部控制率分别为75%（39/52）和51%（21/41）。16例患者（17%）出现淋巴结复发，其中6例伴有局部复发。第1组T1肿瘤的局部控制率为64%（23/36），第2组为100%（16/16）（p<0.01）。对于T2肿瘤，这些数字分别为45%（14/31）和70%（7/10）（p>0.3）。分析中研究了13个参数对局部控制的影响。在单因素分析中，Cox回归肿瘤大小对精算局部复发有显著预测作用（p<0.001）。（摘要截断于250字）
