Boron Neutron Capture Therapy for Head and Neck Epithelial Carcinomas

【背景】基于BNCT治疗腮腺黏液表皮样癌成功的报道，我们从2003年10月开始开展了BNCT治疗头颈部复发或局部晚期上皮癌的临床试验。【患者与方法】2003年10月至2007年9月，3例患者在KUR或JRR-4接受BNCT治疗。每位患者的组织学类型、原发区域及TNM分期如下：患者1：腺泡细胞癌；腮腺；T4N0M0，患者2:ACC；泪囊；T4N0M0，患者3:ACC；上颌窦；T4N0M0。采用18F-BPA-PEP研究获得的肿瘤/正常组织硼浓度比（T/N ratio）进行中子辐照前剂量估计和BNCT后剂量评估，分别采用SERA或JCDS进行。以500 mg/kg体重的剂量静脉给药果糖溶液中的BPA后，使用超热束进行中子辐照，反应堆功率为5.0 MW （KUR）或3.5 MW （JRR-4）。最深处肿瘤剂量计划大于20 Gy-Eq，正常皮肤和粘膜剂量计划小于15 Gy-Eq。[结果]所有患者均表现出局部完全缓解（CR）。所有患者均出现超过耐受水平的皮炎（RTOG/EORTC 2级急性反应）。然而，在BNCT后的几个月内，皮炎就治愈了。患者1在BNCT后19个月出现颈部皮下组织转移。患者1在BNCT后12个月出现脑受累。目前，所有患者均存活，BNCT后存活10至20个月。【结论】本研究表明BNCT是治疗头颈部上皮性癌的一种非常有效的方法。基于良好的结果和样本量，该方法值得进一步研究。

[Background]Based on the reports that success of BNCT in treating mucoepidermoid carcinoma of the parotid gland, we have been conducting BNCT clinical trial on recurrence or locally advanced epithelial carcinomas in the head and neck since October 2003.[Patients and Methods]Three patients were treated with BNCT at KUR or JRR-4 from October 2003 to September 2007. The histologic type of carcinoma, primary region, and TNM staging in each patient were as follows : Patient 1 : acinic cell carcinoma ; palotid gland ; T4N0M0, Patient 2 : ACC ; lacrimal sac ; T4N0M0, Patient 3:ACC ; maxillary sinus ; T4N0M0.The tumor/normal-tissue boron concentration ratio (T/N ratio) obtained from 18F-BPA-PEP study was adopted to the dose estimation before neutron irradiation and dose evaluation after BNCT using SERA or JCDS. Neutron irradiation was performed using an epithermal beam at a reactor power of 5.0 MW (KUR) or 3.5 MW (JRR-4) after intravenous administration of BPA in fructose solution at a dose of 500 mg/kg body weight. The tumor dose at the deepest part and the dose of both normal skin and mucosa were planned more than 20 Gy-Eq and less than 15 Gy-Eq, respectively.[Results]All patients demonstrated regional complete response (CR). All patient suffered from dermatitis (grade 2 RTOG/EORTC acute reaction) that exceeded the tolerance level. However, dermatitis was cured within a few months after BNCT. Patient 1 showed metastasis to subcutaneous tissue of the neck 19 months after BNCT. Patient 1 had brain involvement 12 months after BNCT. At present, all the patients are living, surviving 10 to 20 months after BNCT.[Conclusion]This study shows that BNCT is a quite effective therapy for the epithelial carcinomas of the head and neck. Based on the promising results and the sample size, further research is warranted on this method.