Intraoral Cone Radiotherapy for Cancer of the Oral Cavity

Full Article

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.






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。