Pernot M, Hoffstetter S, Peiffert D, Aletti P, Lapeyre M, Marchal C, Luporsi E, Bey P, Nancy V L
Department of Brachytherapy, Centre Alexis Vautrin, Vandoeuvre Les Nancy, France.
Otolaryngol Head Neck Surg. 1996 Dec;115(6):519-26. doi: 10.1016/S0194-59989670006-2.
Our study focuses on a series of 1344 cases of carcinoma of the oral cavity and oropharynx treated between 1973 and 1992. Brachytherapy was always performed with iridium 192, either alone or in combination with external-beam irradiation or with surgery for the treatment of the primary tumor. For the oral cavity, we studied 565 cases of mobile tongue. The local control and overall survival rates, respectively, at 5 years are as follows: for T1, 92% and 70%; for T2, 62% and 42%; and for T3, 50% and 29%. For the subgroup T1T2NO, there was a better prognosis for treatment by brachytherapy of the primary lesion alone (p < 0.0001). Two hundred seven cases of floor-of-mouth carcinoma have been reported. The T3T4 patients were not considered surgical candidates. The local control and overall survival rates, respectively, at 5 years are as follows: for T1, 97% and 71%; for T2 72% and 42%; and for T3, 51% and 35%. Ninety-seven patients were treated by postoperative brachytherapy. These were patients for whom the margins after surgery were positive or narrow. A technique termed the modified bridge is described for lesions located in the mandible. Carcinomas of the buccal mucosa are rare in our country; only 42 cases were treated in this comparison of two techniques, and the overall survival rate was 48%. Epidermoid carcinomas of the oropharynx have nearly always been treated by a combination of external-beam irradiation and brachytherapy because of the bilateral node risk. Seventy-two patients with epidermoid cancers of the base of the tongue had an overall survival rate of 44%. The tonsil, soft palate, and pillars benefited from the use of the loop technique of brachytherapy combined with external-beam irradiation. Three hundred sixty-one patients were treated. Among these patients were two groups with different prognoses. Patients with tonsil, soft palate, and posterior pillar carcinomas had a local control rate of 84% and an overall survival rate of 57%. Conversely, the anterior pillar and the pharyngoglossal sulcus have a local control rate of only 65% and an overall survival rate of 38%. Statistical analysis revealed the prognostic factors for local control. The complications were classified into four grades: minor (20%), moderate (9%), major (4%), or inducing death (0.2%). The bone complications of grade 2 or 3 are more frequent for the floor of the mouth than for other locations.
我们的研究聚焦于1973年至1992年间治疗的1344例口腔和口咽癌病例。近距离放射治疗始终使用铱192进行，单独使用或与外照射或手术联合用于原发性肿瘤的治疗。对于口腔，我们研究了565例活动舌癌病例。5年时的局部控制率和总生存率分别如下：T1期为92%和70%；T2期为62%和42%；T3期为50%和29%。对于T1T2NO亚组，单纯对原发性病变进行近距离放射治疗的预后较好（p < 0.0001）。已报告207例口底癌病例。T3T4期患者不被视为手术候选者。5年时的局部控制率和总生存率分别如下：T1期为97%和71%；T2期为72%和42%；T3期为51%和35%。97例患者接受了术后近距离放射治疗。这些患者手术切缘阳性或切缘狭窄。描述了一种针对下颌骨病变的改良桥接技术。我国颊黏膜癌罕见；在这两种技术的比较中仅治疗了42例，总生存率为48%。口咽表皮样癌几乎总是采用外照射和近距离放射治疗联合的方式进行治疗，因为存在双侧淋巴结转移风险。72例舌根表皮样癌患者的总生存率为44%。扁桃体、软腭和咽柱采用近距离放射治疗的环技术联合外照射治疗效果良好。共治疗了361例患者。在这些患者中有两组预后不同。扁桃体、软腭和后柱癌患者的局部控制率为84%，总生存率为57%。相反，前柱和咽舌沟的局部控制率仅为65%，总生存率为38%。统计分析揭示了局部控制的预后因素。并发症分为四个等级：轻度（20%）、中度（9%）、重度（4%）或致死（0.2%）。口底2级或3级的骨并发症比其他部位更常见。
