Retrospective Study of the Concurrent Intraarterial Chemo-Radiotherapy for Locally Advanced or al Cancers

局部性晚期口腔癌接受同步放射線動脈化學療法之研討

黃鈞民(Chun-Ming Huang) ； 黃志仁(Chih-Jen Huang) ； 黃旼儀(Ming-Yii Huang) ； 李欣樺(Hsin-Hua Lee) ； 吳誌峰(Chih-Fung Wu) ； 陳中和(Chung-Ho Chen) ； 沈茂昌(Maw-Chang Sheen) ； 連熙隆(Shi-Long Lian)

《放射治療與腫瘤學》 15卷3期 (2008/09) Pp. 201-212

https://doi.org/10.6316/TRO/200815(3)201

摘要

目的：本研究的目的在於探討局部性晚期口腔癌接受同步放射線動脈化學療法的臨床結果及併發症。
材料與方法：自2001年9月至2006年7月，共有30位局部性晚期口腔鱗狀上皮細胞癌（其中22位癌症分期之期別為第四期；另外8位為第三期）的病患接受同步放射線動脈化學療法。年齡分佈從32歲到63歲（中位數為45歲）。每個病患在接受放射線治療的同時也都會同步地接受每週一次50毫克methotrexate的動脈化學治療。所有病患所接受的中位放射線劑量為64Gy，中位的追蹤時間有20個月（最短追蹤6個月；最長的追蹤有52個月）。
結果：我們在治療結束之後，利用臨床的理學檢查以及影像學的檢查，來評估病灶對治療的反應效果。結果發現有53%在治療後病灶完全消除；23%的病例病灶為部分消除；17%的病灶對治療沒有反應；7%的病灶治療後病灶有擴大的情形。在治療期間有33.3%的病患導致第三級的口腔黏膜炎；26.6%的病患有第三級的吞嚥困難；3%有第三級的白血球低下症。一年的存活率有60.4%。分析的結果，我們發現在治療後病灶能完全或部分消除的病患有比較好的存活率。
結論：我們初步的結果顯示局部性晚期口腔癌接受同步放射線動脈化學療法是可行的，特別是口腔癌中的舌癌及齒齦癌對於同步放射線動脈化學療法有比較好的治療成效。儘管如此，同步放射線動脈化學療法對於局部性晚期口腔癌的療效，還需要更大型的前瞻性研究來探討。

關鍵字

口腔癌 ； 同步放射線動脈化學療法 ； 滅可善注射液

並列摘要

Purpose: The aim of this study is to investigate the clinical outcomes and complications of intraarterial chemotherapy and concurrent radiation therapy (IACCRT) for locally advanced oral cancers.
Materials and Methods: Between September, 2001 and July, 2006, 30 patients with locally advanced oral squamous cell carcinoma (stage Ⅳ: 22 patients and stage Ⅲ: 8 patients) received concurrent intraarterial chemo-radiotherapy in our department. The age ranged from 32 year-old to 63 year-old (median, 45 year-old). Each patient received a single bolus of 50 mg of methotrexate intraarterially every week while undergoing irradiation. The median irradiation dose was 64 Gy with 1.8-2.0 Gy daily fractions. The median follow-up period was 20 months (range, 6-52 months).
Results: The response rate was evaluated by clinical examination and imaging study after IACCRT and the results were as follows: complete response, 53% (16/30); partial response, 23% (7/30); no response, 17% (5/30); progression, 7% (2/30). The major toxicities included grade 3 mucositis (10/30, 33.3%), grade 3 dysphagia (8/30, 26.6%), and grade 3 leukopenia (1/30, 3%). The estimated 1-year survival rate was 60.4%. Patients with complete or partial response were associated with better overall survival by Kaplan Meier survival analysis (log-rank test, p=0.05).
Conclusion: Our preliminary data suggests IACCRT for locally advanced oral cancers is feasible. We have inferred a conclusion from the facts that tongue and gingival cancers have better response to IACCRT than buccal cancer does. Nevertheless, the result was not statistically significant. Further larger prospective study with detailed case selection is necessary.

並列關鍵字

Oral cancer ； IACCRT ； Methotrexate