高線量率イリジウム線源を用いた組織内小線源治療による舌癌治療の検討

Long-term outcomes of interstitial brachytherapy with the high dose rate iridium source for tongue cancer treatment

Creators Horinaga Daiju

Creators Mano Takamitsu

Creators Uchida Kenichiro

Creators Harada Koji

Creators Umeda Hirotsugu

Creators Okafuji Masaki

Creators Mishima Katsuaki

Creators Ueyama Yoshiya

当科において,舌扁平上皮癌患者に対しておこなった高線量率組織内照射の治療効果を検証するため,他の文献的考察をくわえて検討した.症例は14例,男性9例,女性5例で,年齢は40~88歳(中央値:71.0歳)であった.初期治療として3例に外部照射が,11例に動注化学療法が施行された.5年局所制御率は100%であった.局所再発が2例(14.3%),頚部リンパ節転移が3例(21.4%)に認められたが,1例の他病死を除き全例非担癌状態で生存していた.主要な有害事象は口腔粘膜炎,口内乾燥,潰瘍を伴った骨露出であった.特に口腔粘膜炎はすべての症例で認められた.舌癌に対する高線量率組織内照射は口腔機能温存の面から効果的で許容しうる方法である.しかしながら,放射線による顎骨壊死などの可能性がある.そのため,われわれは注意深く治療後の経過を観察する必要がある.

Fourteen patients with tongue squamous cell carcinoma were treated with high-dose-rate interstitial brachytherapy. The patients consisted of nine males and five females aged from 40 to 88 years(median age, 71.0 years).As an initial treatment, external radiotherapy was combined for three patients, and intra-arterial chemotherapy was combined for eleven patients.Five-year local control rates were 92.9%. Local recurrence and delayed neck lymph nodes metastasis were detected in two cases(14.3%)and three cases(21.4%)respectively, but all patients lived in non-cancer bearing now, except the one who died from the other illness. The major adverse events were oral mucositis, xerostomia and bone exposure with ulcer. Especially oral mucositis was found in all case, and bone exposure and xerostomia often occurred as late complication. Our date suggested that high-dose-rate brachytherapy for tongue cancer patient may be an effective and an acceptable therapy as a functional preservation therapy against oral cancer. However, this therapy may have a risk of occurrence of radiation osteonecrosis. Thus, we must follow the patient closely.

[ISSN]0513-1731

[NCID]AN00243156