Intraoral Cone Radiotherapy for Cancer of the Oral Cavity
SY Wong, CS Wong, TW Leung, ML Law, WY Ng, AS Lee, WK Sze, Y Tung
Hong Kong J Radiol 2011;14:141-6
Objective: To evaluate treatment results of intraoral cone therapy with or without external radiotherapy as primary treatment in patients with carcinoma of oral cavity.
Methods: Between the years 1997 and 2011, 14 patients were identified for retrospective review. Statistical analysis by the Kaplan Meier method was performed for local disease–free survival, disease-free survival, and overall survival.
Results: The median patient age was 68 (range, 45-83) years; they all had squamous cell carcinoma and 12 (86%) were male. The tongue was the commonest primary site (n = 9). In all, nine (64%) has significant comorbidities; five (36%) were not fit for surgery, four (29%) refused surgery, and five (36%) aimed for organ preservation. Eleven (79%) were T1 or T2, three (21%) were T3 or T4. Two (14%) patients received intraoral cone therapy alone, and 12 (86%) both intraoral cone and external radiotherapy. Two (14%) received concurrent chemotherapy and radiotherapy. The most commonly used regimen was 3 Gy/fr for 7 to 8 fractions (ranging from 2-3 Gy/fr for 3-19 fractions). The dose of locoregional external radiotherapy ranged from 50 to 66 Gy (median, 50 Gy). The median follow-up time was 55 (range, 2-157) months. The 2-year and 5-year disease-free survival were 91% and 80%, and 2-year and 5-year overall survival were 71% and 54%, respectively. Three patients (21%) developed local recurrence and all have salvage surgery done. Five-year local control rate was 83%. Three patients (21%) developed grade-3/4 mucositis, one patient (7%) developed radionecrosis, one patient (7%) developed sarcoma.
Conclusion: Intraoral cone radiotherapy is an effective means for treating primary tumours in the oral cavity with organ preservation. It is a feasible therapeutic option if the patient refuses, is too old, or not fit for surgery or brachytherapy.
中文摘要
口腔內置聚束管放射治療腫瘤
王韶如、黃志成、梁道偉、羅文龍、吳雲英、李安誠、施永健、董煜
目的：評估利用口腔內置聚束管治療在有或無體外放射治療的情況下應用於口腔腫瘤治療的結果。
方法：回顧1997至2011年期間14名口腔腫瘤患者的病例報告。統計學分析用Kaplan Meier法計算原位 無瘤生存率、無瘤生存率及總生存率。
結果：14名口腔腫瘤患者均為鱗狀細胞癌，他們年齡介乎45至83歲，中位數68歲。12人（86%） 為男性 。9人的原發灶為舌癌。14名患者中，9人（64%）有嚴重共病、5人（36%）並不適合接受手術、4人（29%）拒絕接受手術、5人（36%）旨在保留器官。11人（79%）屬T1或T2期，3人 （21%）屬T3或T4期。2人（14%）只接受口腔內置聚束管治療，另12人（86%）接受口腔內置聚束 管及放射治療；2人（14%）同時接受化療及放射治療。最常用的劑量為7至8次，每次3 Gy；所用的 劑量介乎3至19次，每次2至3 Gy。局部放射治療的劑量介乎50至66 Gy（中位數50 Gy）。隨訪期介 乎2至157個月，中位數55個月。兩年無瘤生存率及總生存率分別為91%及71%；五年無瘤生存率及總 生存率分別為80%及54﹪。3名患者（21%）原位復發，全部只接受挽救性手術。五年局部控制率為 83%。3人（21%）出現III／IV期黏膜炎、1人（7%）有放射性壞死、1人（7%）出現肉瘤。
結論：口腔內置聚束管放射治療有效處理口腔內原發腫瘤，並且可以保留病人器官。如果病人年紀 太大、拒絕或不適宜接受手術或近距離放射治療，口腔內置聚束管放射線治療可作為一個可行的治 療方法。