Lapeyre M, Peiffert D, Hoffstetter S, Pernot M, Dolivet G, Simon C, Chassagne J F, Bey P
Brachytherapy Department, Centre Alexis Vautrin, Nancy, France.
Eur J Surg Oncol. 1997 Jun;23(3):243-6. doi: 10.1016/s0748-7983(97)92484-7.
The aim of this study was to analyse the role of post-operative brachytherapy (BT) in a group of patients with a high risk of local relapse (positive or narrow surgical margins) for squamous cell carcinoma of the mouth floor (SCCFM). A comparison with post-operative external beam irradiation (EBI) in a group of patients with standard risk of local relapse for SCCFM with free margins is performed to estimate the benefit of BT. From 1979 to 1992, an initial group of 32 patients with SCCFM (12, T1-2; 20, T3-4x) received an Ir 192 low dose rate BT using plastic tubes (+EBI for 20 patients) after surgery with positive or close margins. BT was applied in one or two planes to the surgical scar. The mean dose of BT was 57 Gy (range: 50-60) for exclusive BT and 22 Gy (range: 15-30) when a boost was applied (mean EBI dose = 50 Gy). During the same period, 36 patients had post-operative external irradiation alone after satisfactory surgical resection. Excluding the post-operative margin, these two groups were comparable for other prognostic factors. The mean follow-up was 46 months (range: 5-145) with a minimum follow-up of 2 years. For BT and EBI groups, the 5-year results (Kaplan-Meier) were, respectively, overall survival 62% and 43%, local control 81% and 60% (P = 0.09) (log-rank) and severe complications 4/32 and 1/36. Post-operative BT achieves good local control for patients with narrow or positive margins by increasing the dose to the surgical scar, with good tolerance. Given these encouraging results, we confirm this treatment for these patients.
本研究的目的是分析术后近距离放射治疗（BT）在一组具有局部复发高风险（手术切缘阳性或切缘狭窄）的口腔底鳞状细胞癌（SCCFM）患者中的作用。将其与一组具有标准局部复发风险且切缘阴性的SCCFM患者的术后外照射（EBI）进行比较，以评估BT的益处。1979年至1992年，最初一组32例SCCFM患者（12例T1 - 2期；20例T3 - 4x期）在手术切缘阳性或切缘接近的情况下，术后使用塑料管进行铱192低剂量率BT（20例患者联合EBI）。BT在一个或两个平面应用于手术切口。单纯BT的平均剂量为57 Gy（范围：50 - 60），进行增量照射时为22 Gy（范围：15 - 30）（平均EBI剂量 = 50 Gy）。同期，36例患者在手术切除满意后仅接受术后外照射。除手术切缘外，这两组在其他预后因素方面具有可比性。平均随访时间为46个月（范围：5 - 145），最短随访2年。对于BT组和EBI组，5年结果（Kaplan - Meier法）分别为总生存率62%和43%，局部控制率81%和60%（P = 0.09）（对数秩检验），严重并发症发生率分别为4/32和1/36。术后BT通过增加手术切口的剂量，对切缘狭窄或阳性的患者实现了良好的局部控制，且耐受性良好。鉴于这些令人鼓舞的结果，我们确认对这些患者采用这种治疗方法。
