放射性¹²⁵Ⅰ粒子植入治疗头颈部肿瘤

【作者】 王俊杰； 冉维强； 袁惠书； 姜玉良； 刘江平； 李金娜； 姜伟娟；

【Author】 WANG Jun-jie RAN Wei-qiang YUAN Hui-shu JIANG Yu-liang LIU Jiang-ping LI Jin-na JIANG Wei-juan The Cancer Center of Peking Universery Third Hospital (10083 , Beijing)

【机构】 北京大学第三医院肿瘤治疗中心；

【摘要】 目的: 探讨超声或CT引导下放射性125I粒子组织间植入治疗头颈部肿瘤的技术可行性和近期疗效。方法:40例头颈部癌和转移癌患者。4例采刚全身麻醉,36例采用局部麻醉。4例在CT引导下行125I粒子植入术．36例行超声引导下125I粒子植入术。粒子针平行排列,间距1-1．5 cm,原发肿瘤植入靶体积影像学边界外放1cm,转移瘤植入靶体积为影像学边界。粒子间距1cm。肿瘤周边匹配剂量(Matched peripheral dose,MPD)90G y-145Gy,每颗粒子活度0．40mCi-0．70mCi,每个病灶植入3颗-84颗粒子。5例患者术后1周加外放疗,每次200cGy,总剂量45-50Gy。术后24小时拍头颈正侧位平片或 CT行质量验证。术后24-48小时拍胸部X线片了解有无粒子移位或游走。结果随访3月- 33月,10例舌癌3例完全缓解,3例部分缓解,3例稳定,1例进展。2例伴颈部淋巴结转移完全缓解。局部控制率为60％,中位生存期11个月,1年和2年生存率分别为87．50％和35％。14例头颈部癌粒子治疗后,局部控制率为76．47％,中位生存期9个月,1年和2 年生存率为66．08％和24％。16例头颈部转移癌粒子治疗后,局部控制率95．23％,中位生存期9个月,1年和2年生存率为54．55％和32．73％。没有1例发生严重的皮肤反应。结论放射性125I粒子粒子植入治疗头颈部癌疗效确切,尤其是对那些手术后或放疗复发患者提供了一种新的、可行的、安全和微创治疗手段。更多还原

【Abstract】 Objective To investigate the technological feasibility, efficacy and morbidity of 125I seeds implantation in head and neck cancer. Method forty patients with head and neck cancer were treated with 125I seeds interstitial brachytherapy guided by ultrasound or CT. Thirty-six patients were performed under local anesthesia and four were under general anesthesia. Thirty-six patients were treated with 125I seed implantation under ultrasound guidance and four cases under CT guidance. Seed needles were implanted parallel to each other, at 1-1.5cm apart. Mick applicator was used to each needle to implant seed at 1-1. 5 cm apart. The radioactive activity ranged 0.40-0. 70mCi, the matched peripheral doses were 90-145Gy. The mean number of 125l seed were 3-88. Five cases received external beam radiation one week after seed implantation, the total doses were 45-50Gy, 200cGy/f. All of the cases had X-ray or CT after implantation for quality evaluation and had routine chest X ray within twenty-four to forty-eight hours after seed implantation. Results Follow-up from 3-33 months. Amoung 10 tongue carcinoma patients, complete response was in 3 cases, partial response was in three cases, no change was in three cases, progressive disease was in one case, the local control rate was 60%, the median survival time was 11 monthes, one year and two year survival rate were 87. 50% and 35% respectively. The local control rate was 76.47% , one year and two year survival rate 66. 08% and 24% respectively, the median survival time was 9 monthes in 14 patients with recurrent cancer of head and neck The local control rate was 95.23 %, one year and two year survival rate were 54. 55% and 32. 73%, the median survival time was 9 monthes in 16 patients with metastatic cancer of head and neck One seed migrated to maxilla and seeds losing had happened in two cases, but did not showed any clinical relative mobidity. Conclusion 125I seed implantation for recurrent or metastates of head and neck cancer under guidance of ultrasound or CT was safety, minimally invasion, low morbidity and high efficacy, especially for recurrent and matastatic cancer of head and neck after surgery or radiotherapy.更多还原