HDR Brachytherapy for Superficial Non-Melanoma Skin Cancers
HDR Brachytherapy for Superficial Non-Melanoma Skin Cancers
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DOI：
10.1111/j.1754-9485.2012.02466.x
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发表时间：
2013-04-01
影响因子：
1.6
通讯作者：
Gauden, Stan
中科院分区：
文献类型：
--
作者：
Gauden, Ruth;Pracy, Martin;Gauden, Stan
介绍我们的初步经验，使用推荐的高剂量每部分皮肤近距离放射治疗（BT）治疗计划，导致美容效果差。本研究旨在评估在前瞻性患者组中使用莱比锡表面施源器进行高剂量率（HDR）近距离放射治疗，使用延长治疗计划治疗小型非黑色素瘤皮肤癌（NMSC）。方法采用高剂量率近距离放射治疗。36 Gy，处方为3至4 mm，每日3Gy分次给药。在放射治疗期间，每周使用放射治疗肿瘤组标准评价急性皮肤毒性。在治疗完成后定期监测局部反应、迟发皮肤效应和美容效果。结果自2002年3月以来，共治疗了200例236个病灶。中位随访时间为66个月（范围25 - 121个月）。共有162个病变是肉眼可见的，而在74例病例中，由于显微镜切缘阳性，切除后给予BT。基底细胞癌121例，鳞状细胞癌115例。病变位于头颈部（198例）、四肢（26例）和躯干（12例）。局部控制为232/236（98%）。4例患者需要进一步手术治疗复发。在168处治疗病灶（71%）中检测到1级急性皮肤毒性，在81处（34%）中检测到2级急性皮肤毒性。美容效果优良者208例（88%）。13例（5.5%）观察到晚期皮肤色素减退改变。结论应用HDR近距离放射治疗对浅表NMSC进行为期2周的36戈伊照射耐受性良好，局部控制率高，无明显毒性。
Introduction Our initial experience using recommended high dose per fraction skin brachytherapy (BT) treatment schedules, resulted in poor cosmesis. This study aimed to assess in a prospective group of patients the use of Leipzig surface applicators for High Dose Rate (HDR) brachytherapy, for the treatment of small non-melanoma skin cancers (NMSC) using a protracted treatment schedule. Method Treatment was delivered by HDR brachytherapy with Leipzig applicators. 36Gy, prescribed to between 3 to 4mm, was given in daily 3Gy fractions. Acute skin toxicity was evaluated weekly during irradiation using the Radiation Therapy Oncology Group criteria. Local response, late skin effects and cosmetic results were monitored at periodic intervals after treatment completion. Results From March 2002, 200 patients with 236 lesions were treated. Median follow-up was 66 months (range 25121 months). A total of 162 lesions were macroscopic, while in 74 cases, BT was given after resection because of positive microscopic margins. There were 121 lesions that were basal cell carcinomas, and 115 were squamous cell carcinomas. Lesions were located on the head and neck (198), the extremities (26) and trunk (12). Local control was 232/236 (98%). Four patients required further surgery to treat recurrence. Grade 1 acute skin toxicity was detected in 168 treated lesions (71%) and grade 2 in 81 (34%). Cosmesis was good or excellent in 208 cases (88%). Late skin hypopigmentation changes were observed in 13 cases (5.5%). Conclusion Delivering 36 Gy over 2 weeks to superficial NMSC using HDR brachytherapy is well tolerated and provides a high local control rate without significant toxicity.