高剂量率^(192)Ir组织间插植放射治疗口腔口咽癌

Hyperfractionated high dose rate interstitial brachytherapy for carcinoma of the oral cavity and orophanynx

目的 探讨外照射加组织间插植超分割放射治疗口腔、口咽癌的疗效。方法 初治口腔、口咽癌 48例 ,外照射DT30～ 6 5Gy (T1 、T2 期 30～ 5 0Gy,T3 、T4期 5 0～ 6 5Gy) ,加1 92 Ir高剂量率组织间照射DT15～ 35Gy(T1 、T2 期 30～ 35Gy ,T3 、T4期 15～ 30Gy)。结果 原发灶全消率 :T1 期 5 5 ,T2 期 2 3 2 7,T3 期 6 13,T4期 0 3;部分消退率T2 期 4 2 7,T3 期 7 13,T4期 3 3。 3年总生存率和无瘤生存率分别为79 .4%和 5 5 .8%。影响预后的多因素分析结果显示仅与TNM分期、病理类型有关。结论 口腔、口咽癌外照射配合组织间插植近距离照射是早期病例的根治手段 ,对拒绝手术。

Objective To study the results of external beam radiotherapy plus 192 Ir hyperfractionated high dose rate interstitial brachytherapy (HHDR-IBT) for cancer of the oral cavity and oropharynx. Methods Fourty-eight patients with cancer of the oral cavity and oropharynx were treated by external beam radiotherapy (T 1,T 2 30～50 Gy,T 3,T 4 50～60 Gy) followed by 192 Ir HHDR-IBT delivering 15～35 Gy (30～35 Gy for T 1,T 2 and 15～30 Gy for T 3,T 4 in 250～350 cGy per fraction,two fractions per day). Over 3～5 days. Results The complete response rates at 3 months were T 1100% (5/5),T 2 85%(23/27),T 3 46%(6/13),T 4 0%(0/3) and the partial reponse rates:T 2 15% (4/27), T 3 54%(7/13), T 4 100%(3/3). The 3-year survival and disease-free survival rates were 79.4% and 55.8%,respectively.Multivariate analysis showed that TNM stage and pathalogic type were prognostic factors.Conclusions Carcinoma of the oral cavity and oropharynx treated with external beam radiotherapy combined with 192 Ir hyperfractionated high dose rate interstitial brachytherapy ia able to give a good local control for T 1,T 2 lesions with good functional preservation. For T 3,T 4 lesions,this method is able to offer a high palliation.