IMPROVED LOCAL-CONTROL OF NASOPHARYNGEAL CARCINOMA AFTER INTRACAVITARY BRACHYTHERAPY BOOST
IMPROVED LOCAL-CONTROL OF NASOPHARYNGEAL CARCINOMA AFTER INTRACAVITARY BRACHYTHERAPY BOOST
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DOI：
10.1097/00000421-199102000-00002
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发表时间：
1991-02-01
影响因子：
2.6
通讯作者：
WANG, CC
中科院分区：
文献类型：
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作者：
WANG, CC
1976年，我们开始使用腔内铯提升技术作为原发性T2和T3鼻咽癌综合治疗的一部分。起初，我们偶尔为T1病变的患者提供这种手术。在过去的10年里，除T4病变外，所有患者都接受了腔内增强治疗。放射治疗方案包括60-64 Gy的外束剂量，每日一次（q.d）或每日两次（b.i.d）计划，随后通过腔内植入物向粘膜表面增强10-15 Gy，总计约75 Gy。本文介绍了马萨诸塞州总医院从1970年到1988年对146例T1-3鼻咽癌患者进行放疗的经验。76例患者接受腔内增强治疗，70例患者单独接受65 ~ 70 Gy外束治疗。放疗和腔内强化治疗后T1病灶的5年总体精算局部控制率为93%，而未进行近距离强化治疗的T1病灶5年总体精算局部控制率为54% （p值= 0.057）。对于T1-2病变，外置放疗加近距离强化和外置放疗无强化后相应的局部率分别为90%和59%，p = 0.001。T3病变发生率分别为100%和64%，p = 0.090。局部控制改善的原因尚不清楚，可能是由于鼻咽粘膜剂量有所增加。希望改善的有益局部控制效果可以反映在患者生存率的提高上。然而，这些数据需要一项对照随机临床试验来证实。
In 1976 we began using intracavitary cesium boost technique as a portion of comprehensive treatment of primary T2 and T3 nasopharyngeal carcinoma. At first, we offered this procedure sporadically to patients with T1 lesions. For the past 10 years, intracavitary boost has been offered to all patients except those with T4 lesions. The radiation therapy program consists of external beam dose of 60-64 Gy, either once daily (q.d.) or twice daily (b.i.d.) schedule, followed by 10-15 Gy boost to mucosal surface by intracavitary implant, making a total of approximately 75 Gy. This article presents the experience at the Massachusetts General Hospital with 146 patients with T1-3 carcinoma of the nasopharynx irradiated from 1970 through 1988. Seventy-six patients were treated with intracavitary boost and 70 patients were treated up to 65-70 Gy by external beam alone. The overall 5-year actuarial local control rate for the T1 lesions was 93% after radiation therapy and intracavitary boost as compared with 54% without brachytherapy boost (p value = 0.057). For the T1-2 lesions, the corresponding local rates after external radiation therapy and brachytherapy boost and after external beam irradiation without boost were 90 and 59%, respectively, with p = 0.001. For the T3 lesions, the rates were 100 and 64%, respectively, with p = 0.090. The reason for improved local control is unclear and may be due to a somewhat higher mucosal dose to the nasopharynx. Hopefully, the improved beneficial local control effects may be reflected in improved patient survival. However, such data required a controlled randomized clinical trial for confirmation.