Treatment of skin carcinomas of the face by high-dose-rate brachytherapy and custom-made surface molds
Treatment of skin carcinomas of the face by high-dose-rate brachytherapy and custom-made surface molds
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DOI：
10.1016/s0360-3016(99)00547-7
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发表时间：
2000-04-01
影响因子：
7
通讯作者：
Guix, R
中科院分区：
文献类型：
--
作者：
Guix, B;Finestres, F;Guix, R
目的：分析通过定制表面模具进行高剂量率（HDR）近距离放射治疗的面部基底细胞或鳞状细胞皮肤癌患者的前瞻性组中获得的结果。方法和材料：1992年3月至1997年3月，共136例面部基底细胞癌或鳞状细胞癌患者接受了铱-192表面霉菌和HDR近距离放射治疗，19名患者使用标准Brock涂抹器治疗，117名患者使用定制的聚甲基丙烯酸甲酯涂抹器治疗，这些涂抹器构建在患者面部的石膏模具上。肿瘤最小剂量为6000 - 6500 cGy，分33 - 36次，最大4 cm病灶为180 cGy/次，大于4 cm的病灶在3周暂停后增加至7500-8000 cGy。使用定制的表面模具，剂量分布在皮肤表面和施用器整个区域的5 mm深度处均匀。在该深度处的最大和最小剂量区域之间的差异从未达到高于规定剂量的5%的值，在定制模具的边缘处，剂量梯度是尖锐的，在距离施用器5 mm处检测到的剂量可以忽略不计。所有患者均为完全缓解者。3例局部复发，1/73例原发肿瘤治疗，2/63例复发肿瘤治疗。所有患者5年时的局部控制率为98%，原发性肿瘤患者为99%，复发患者为87%。所有病例的治疗耐受性均极佳。没有严重的，早期的，或晚期的，并发症detected.Conclusions：放射治疗是一个非常有效的治疗皮肤癌的脸。与HDR近距离放射治疗设备结合使用的定制模具可以实现均匀的剂量分布，在施源器的限制范围内具有急剧的剂量梯度。定制的表面模具使用简单安全，非常适合日常治疗。局部控制良好，后遗症或并发症最少。有可能在不久的将来成为面部皮肤癌的标准治疗方法。(C)2000 Elsevier Science Inc.
Purpose: To analyze the results obtained in a prospective group of patients with basal or squamous cell skin carcinomas of the face treated by high-dose-rate (HDR) brachytherapy via custom-made surface molds.Methods and Materials: A total of 136 patients with basal or squamous cell carcinomas of the face were treated between March 1992 and March 1997 by surface molds and HDR brachytherapy with iridium-192, Nineteen patients were treated with standard Brock applicators and 117 patients with custom-made polymethyl methacrylate applicators, built over a plaster mold obtained of the patient's face. Minimum dose administered to the tumor was 6000 to 6500 cGy in 33 to 36 fractions at 180 cGy/fraction in lesions of up to 4 cm, Lesions greater than 4 cm were boosted up to 7500-8000 cGy after a 3-week pause.Results: With the custom-made surface molds, the dose distribution was uniform in the surface of the skin and at 5 mm depth in the whole area of the applicator. Differences between the areas of maximum and minimum dose at this depth never reached values higher than 5% of the prescribed dose, At the edges of the custom-made molds dose gradient was sharp, with the detected dose at 5 mm from the applicator being negligible. All the patients were complete responders. There were 3 local recurrences, 1/73 patients treated for primary tumor and 2/63 patients treated for recurrent tumor. Actuarial local control at 5 years for all patients was 98%, for those patients with primary tumors 99%, and for recurrent patients 87%, The treatment tolerance was excellent in all cases. No severe, early, or late, complications were detected.Conclusions: Radiotherapy is a highly effective treatment of skin carcinomas of the face. Custom-made molds, to be used in conjunction with HDR brachytherapy equipment, make possible a uniform dose distribution, with a sharp dose gradient in the limits of applicators. Custom-made surface molds are easy and safe to use, and they fit very accurately for daily treatment. Local control is excellent with minimal sequelae or complications. Probably they will become the standard way of treatment of face skin carcinomas in the near future. (C) 2000 Elsevier Science Inc.