Behar R A, Martin P J, Fee W E, Goffinet D R
Department of Radiation Oncology, Stanford University School of Medicine, CA.
Int J Radiat Oncol Biol Phys. 1994 Jan 1;28(1):221-7. doi: 10.1016/0360-3016(94)90161-9.
To evaluate the results, techniques, indications and complications of interstitial brachytherapy in the management of squamous cell carcinomas of the tonsil and soft palate, we reviewed the Stanford University Medical School experience with this modality.
Between May 1975 and January 1990, 37 patients with squamous cell carcinomas of the Tonsillo-Palatine region were treated with a combination of external beam irradiation and a removable Iridium-192 interstitial implant. The mean age of these patients was 56. Twenty-two were males and 15 were females. The stage distribution included four patients with Stage I, 5 with Stage II, 10 with Stage III, and 18 with Stage IV cancers. Thirty-two percent (12/37) of these patients had T3 or T4 lesions. Forty-nine percent (18/37) had stage N2 or N3 cervical lymphadenopathy. All 37 patients received initial external beam irradiation to the primary, bilateral necks, and supraclavicular region (mean dose: 5400 cGy, range 4000-6600). Eighteen patients (49%) also received neck dissections. All 37 patients received an interstitial Irridium-192 implant using a combination intraoral swage and external looping technique. The mean dose was 2700 cGy (range 2000-4000 cGy) to an average volume of 24 cc (range 5-81).
Local control was obtained in 95% (35/37) of the patients. Eighty-seven percent (32/37) of the patients have remained disease-free in the neck. Nine patients have developed second primary lesions, and one developed pulmonary metastasis. Fifteen patients have died (6 succumbed to their cancers, 6 to second primaries, 2 to intercurrent disease, 1 from an unknown cause). The actuarial freedom from relapse is 75%, and overall survival is 64% at 5 years, with a mean follow up of 43 months (range 5-110). Complications were limited to one case of osteoradionecrosis of the mandible and one tonsillar ulcer. Functional and esthetic integrity was preserved in most of these patients.
Iridium-192 interstitial implant boost combined with external beam radiation therapy is a safe and effective therapy in the management of locally advanced carcinomas of the tonsil and soft palate.
为评估组织间近距离放射疗法在扁桃体及软腭鳞状细胞癌治疗中的效果、技术、适应证及并发症，我们回顾了斯坦福大学医学院在该治疗方式上的经验。
1975年5月至1990年1月期间，37例扁桃体 - 腭部区域鳞状细胞癌患者接受了外照射与可移除铱 - 192组织间植入联合治疗。这些患者的平均年龄为56岁。男性22例，女性15例。分期分布为：Ⅰ期4例，Ⅱ期5例，Ⅲ期10例，Ⅳ期18例。这些患者中32%（12/37）有T3或T4病变。49%（18/37）有N2或N3期颈部淋巴结转移。所有37例患者均接受了对原发灶、双侧颈部及锁骨上区域的初始外照射（平均剂量：5400 cGy，范围4000 - 6600）。18例患者（49%）还接受了颈部清扫术。所有37例患者均采用口腔内模和外部环形技术联合进行铱 - 192组织间植入。平均剂量为2700 cGy（范围2000 - 4000 cGy），平均体积为24 cc（范围5 - 81）。
95%（35/37）的患者获得了局部控制。87%（32/37）的患者颈部无疾病复发。9例患者出现了第二原发灶，1例发生了肺转移。15例患者死亡（6例死于癌症，6例死于第二原发灶，2例死于并发疾病，1例死因不明）。5年时无复发生存率为75%，总生存率为64%，平均随访43个月（范围5 - 110）。并发症仅限于1例下颌骨放射性骨坏死和1例扁桃体溃疡。大多数患者的功能和美观完整性得以保留。
铱 - 192组织间植入加强联合外照射放疗是治疗局部晚期扁桃体及软腭癌的一种安全有效的疗法。
