Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_4624_Библиотеки_им_академика_М_И_Перельмана

group presented 2 local and 4 regional recurrences (9 out of 15 free to relapse), EBRT group showed 2 local and 6 regional recurrences (1 out of 9 free to relapse) while group treated with combination of surgery and RT showed 4 out of 8 recur­rences, 1 local and 3 regional. Finally, Fornelli advocated for surgery that showed the best overall cure rate and a locoregional control rate better than EBRT alone, suggesting elective neck irradiation (ENI) only for selected patients [12].

66.3% while DSS was 80.7%. According to their observations, the authors con­cluded that TR can be chosen as the reference treatment option [17].

Between 1981 and 1984, 22 patients were treated with IRT, in three cases in association with EBRT, at Rotterdam RadioTherapeutic Institute. Only one patient had a recurrence and underwent total rhinectomy, the 2-year survival was 92%, and no major complications were described. The authors proposed IRT with iridium alone as standard treatment for early and supercial tumor and a combination of IRT and EBRT for invasive tumors, while surgery should be reserved only for recur­rence [23].

Local control rate in T1 according to Wang or less than 2 cm lesions was respec­tively 89% and 97%, while in T2 according to Wang or bigger than 2cm tumors was respectively 64% and 57%, with an overall survival in the whole series of 65% and an RFS of 80% [28]. In a more recent series, collected between 1991 and 2005in the same institution, 64 Wang T1/T2N0 cancers were treated with HDR-IRT: in 50 patients primarily, in 14 cases after an extensive excision biopsy. 5-year LRFS and OS observed were 89% and 58% in T1 tumor and 100% and 78% in T2 lesion, respectively. One-hundred percent of patients reported a maximum score in cos­metic and functional outcome evaluation for IRT while the patients with previous extensive excision biopsy presented worse cosmetic outcomes. Based on these results and on the relatively low cost of IRT, the authors advocated for this tech­nique [29].

Between 1986 and 1994, at Mount Vernon Hospital, Northwood, 21 patients underwent continuous hyperfractionated accelerated radiotherapy (CHART), 3 daily fractions over 12 consecutive days for a total dose of 54Gy, on primary lesion. No ENI was performed. Overall recurrence-free survival and local control rate were 81% and 86%. One major complication was described (a bilateral blindness due to optic nerves and chiasma damage), while no late skin alterations were observed. Due to survival outcome comparable to surgery or other radiotherapy technique, optimal tolerance even in elderly patients, excellent aesthetic results, and adaptabil­ity to small as well as extensive lesions, CHART was presented as a possible sched­ule for RT, the treatment of choice of NVSCC [31].

In 1999, Mendenhall published a series of 60 patients treated at University of Florida in 1970–1995. In total, 56 lesions were primary irradiated, and 4 T4 cancers underwent high dose preoperative irradiation followed by surgical resection. Sixteen patients were treated with EBRT, 13 patients implanted with IRT, 31 patients received a combination of the two modalities. Local control rate after radiotherapy alone was 85%: 94% in UICC T1/T2 cancer, 83% in T4 without bone invasion, 0/3in case of bone invasion. Initial and ultimate regional control rate was 88% in N0 with primary site controlled and no ENI.Five-year OS observed in case of RT alone was 74%. No severe complications were described in RT alone group, only minimal or moderate soft tissue necrosis in 21% of patients, while signicant sequelae-like bone exposure, wound breakdown, or surgery for suspected but not real recurrence was observed in three out of four patients who underwent surgery after RT [33]. In 2016, Wray etal. presented an update of the series to 99 patients: 13 patients underwent RT and surgery while 86 patients were treated with RT alone, 39 patients with EBRT, 15 patients with brachytherapy, and 45 with a combination of the two modalities. ENI was performed in 25 N0 advanced tumors (T4 or poorly differentiated lesions). Five-year initial and ultimate local control rates were 88% and 94% in the whole series, 88% and 93% in RT alone group. Five-year initial and ultimate N0 regional control rates were 87% and 97%, while OS and DSS were 75% and 91% in all patients and 77% and 94% in RT alone group. The authors observed an overall local control of 100% in patients treated with brachytherapy: a local con­trol rate of 88% in T1/T2 tumors and 75% in T3/T4 cancer treated with combination of EBRT and brachytherapy, and a local control rate of 86% in T1/T2 tumors and 77% in T3/T4 tumors irradiated with EBRT alone. So, Wray and colleagues con­cluded that primary RT is recommended for tumors smaller than 4cm, while for bigger lesions they suggested a combination of surgery and RT.ENI was recom­mended only in T3/T4 tumors or in case of recurrence [34].

At VU University Medical Center, Amsterdam, 56 Wang T1/T2 NVSCCs were primarily irradiated between 1980 and 2000: before 1997, 32 patients were treated with EBRT and IDR brachytherapy boost; after 1997, 9 patients underwent EBRT alone, and 15 lesions were treated with EBRT and HDR Brachytherapy boost. Two­year initial local control rate was 79% in whole series; in particular, in EBRT + IDR group was 75%, in EBRT group 88%, and in EBRT + HDR group 86%. Two- year initial and ultimate regional control rates were 87% and 97%. At 5-year follow- up, the authors observed ultimate local control rate of 95%, OS of 66%, and DSS of 87%. In conclusion, the authors advocated for radiotherapy in T1/T2 tumors, choos­ing the technique depending on the extension of primary lesion and on radiation oncologists’ training [35].

exclusive brachytherapy at Department of Radiation Oncology of Radboud University Nijmegen Medical Centre between 1992 and 2010: 38 patients with interstitial catheters and 22 with a mold technique. Three­year initial and ultimate local control rates were 91% and 96%, while initial and ultimate regional control rates were 93% and 96% [36]. In an update of this series, 42 new patients were treated in 2010–2014 for a total of 102 Wang T1/T2 patients.

Authors observed that 5-year initial and ultimate local control rates were 95% and 98% (100% in patients treated after 2010) and an initial and ultimate regional con­trol rates of 91% and 96%, 88% in the group enrolled after 2010. After 5years of follow-up, OS and DSS were 72% and 94% in the whole series, 83% and 97% in the new patients enlisted group. Toxicity due to radiation was considered acceptable, patients reported good functional and cosmetic outcomes. The authors advocated for brachytherapy for Wang T1 and T2 and even in well-selected larger lesions, while ENI was not recommended [37].