目的:喉癌的治疗目标是保留喉和根治。早期喉癌通常首选喉保留疗法。当喉癌局部复发时,患者经常被迫接受全喉切除术,导致声音功能的丧失。然而,许多放疗后有残留或复发疾病的喉癌患者希望保留自己的声音。这项研究的目的是研究使用BNCT作为根治性照射后残留或复发性喉癌的喉保留治疗方法的可能性。
方法:本研究包括15例因喉癌根治性放疗后残留或复发性喉癌而接受BNCT治疗的患者。所有患者的治疗次数为一次照射。在BNCT之前,喉癌复发分期为rT1aN0、rT2N0、rT2N1、rT3N0、rT3N1和rT4aN0,六,一,三,一,三个病人,分别。BNCT前的中位最大肿瘤直径为15mm(8-22mm)。所有患者在BNCT之前进行了气管造口术,以减轻BNCT后喉水肿引起的上气道狭窄的风险。在BNCT和3个月时的对比增强CT扫描后,每月使用喉镜对治疗效果进行回顾性评估。根据检查结果和对患者的访谈评估治疗的安全性。
结果:BNCT后的中位住院时间为2天(1-6)。15例局部复发性喉癌患者BNCT后3个月的有效率为93.3%,CR率为73.3%。与BNCT相关的最常见的不良事件是喉水肿,发生在BNCT后第二天的9例患者中。所有患者喉头水肿的平均病程在BNCT后第二天达到峰值,并在1周后几乎恢复。一名患者患有双侧声带运动障碍。没有人因为预防性气管造口术而呼吸困难。没有发生4级或更高的不良事件。其他2级不良事件包括咽部粘膜炎,腹泻,喉咙痛.BNCT后三个月,9例患者拔除气管切开管,在三名患者中放置了视网膜插管,和语音套管被放置在三个病人。
结论:BNCT治疗局部复发性喉癌可以安全地对肿瘤组织进行根治性照射,即使在接受根治性放疗的患者中。BNCT已显示出对复发性喉癌的抗肿瘤作用。然而,需要对治疗结果进行进一步的长期观察.
OBJECTIVE: Laryngeal preservation and a radical cure are the treatment goals for laryngeal carcinoma, and larynx-preserving therapy is generally preferred for early-stage laryngeal carcinoma. When laryngeal carcinoma recurs locally, patients are often forced to undergo total laryngectomy, resulting in loss of vocal function. However, many patients with laryngeal carcinoma who have residual or recurrent disease after radiotherapy wish to preserve their voice. The purpose of this study was to investigate the possibility of using BNCT as a larynx-preserving treatment for residual or recurrent laryngeal carcinomas following radical irradiation.
METHODS: This study included 15 patients who underwent BNCT for residual or recurrent laryngeal carcinoma after radical laryngeal carcinoma irradiation. The number of treatment sessions for all patients was one irradiation. Before BNCT, the recurrent laryngeal carcinoma stage was rT1aN0, rT2N0, rT2N1, rT3N0, rT3N1, and rT4aN0 in one, six, one, three, one, and three patients, respectively. The median maximum tumor diameter before BNCT was 15 mm (8-22 mm). All patients underwent a tracheostomy before BNCT to mitigate the risk of upper airway stenosis due to laryngeal edema after BNCT. Treatment efficacy was evaluated retrospectively using monthly laryngoscopy after BNCT and contrast-enhanced CT scans at 3 months. The safety of treatment was evaluated based on examination findings and interviews with patients.
RESULTS: The median hospital stay after BNCT was 2 days (1-6). The response rate at three months after BNCT in 15 patients with locally recurrent laryngeal carcinoma was 93.3 %, and the CR rate was 73.3 %. The most frequent adverse event associated with BNCT was laryngeal edema, which occurred in nine patients the day after BNCT. The average course of laryngeal edema peaked on the second day after BNCT and almost recovered after 1 week in all patients. One patient had bilateral vocal fold movement disorders. None had dyspnea because of prophylactic tracheostomy. No grade four or higher adverse events occurred. Other grade 2 adverse events included pharyngeal mucositis, diarrhea, and sore throat. Three months after BNCT, tracheostomy tubes were removed in nine patients, retinal cannulas were placed in three patients, and voice cannulas were placed in three patients.
CONCLUSIONS: BNCT for locally recurrent laryngeal carcinoma can safely deliver radical irradiation to tumor tissues, even in patients undergoing radical irradiation. BNCT has shown antitumor effects against recurrent laryngeal carcinoma. However, further long-term observations of the treatment outcomes are required.