【作者】 黄明伟； 张建国； 张杰；

【Author】 Huang Ming-Wei Zhang Jian-Guo Zhang Jie Peking University School of Stomatology, Beijing 100081

【机构】 北京大学口腔医学院颌面外科；

【摘要】 目的:探讨碘-125放射性粒子在颌骨及其周围恶性肿瘤治疗中的初步应用,并评价其初期疗效。方法:2004 年至今就诊于北京大学口腔医院的10例病人,其中男5例, 女5例,年龄34—92岁(中位年龄66岁),病理诊断颌骨恶性肿瘤包括一例中央性颌骨癌、一例下颌骨肉瘤;颌周恶性肿瘤包括三例牙龈癌、四例口底癌、一例硬腭腺样囊性癌,其中7例侵犯颌骨。10例病人分成三组:单纯粒子植入组织间放射治疗组、手术后粒子植入组织间放疗组、手术后粒子植入组织间并结合义齿式布源器放疗组。所有病例粒子植入前行CT检查,然后通过TPS治疗计划系统设计植入计划,局麻下植入碘-125粒子,第三组病例要同时佩戴义齿式布源器。患者术后一周,2月行CT检查,TPS验证。验证指标包括:靶区体积、D100、D90、D80、DVH及适形性。10例病人的处方剂量为60～80Gy,碘-125粒子活度为0．5mci／粒～ 0．7mci／粒,植入粒子9～41粒(平均22粒／人)。患者复查时填写生活质量调查表。结果:术后一周内验证,10位患者的植入情况均达到验证要求。随访3—22个月(中位随访时间为 8月),第一组患者肿瘤缩小60％,疼痛症状明显缓解。第二组及第三组术后病人,局部均无复发(7／7)。10例病人中3 例出现口腔溃疡,4～8周自愈,未出现其他并发症。生活质量调查显示患者的生活质量较治疗前提高。结论:①碘- 125放射性粒子治疗为综合治疗颌骨及其周围恶性肿瘤提供了有效,微创且简便易行的方法,同时有保存颌骨功能,并发症少的优点。②义齿式布源器为应用放射性粒子治疗侵犯牙龈及硬腭的恶性肿瘤提供了一种可行的方法。更多还原

【Abstract】 Objective: To study the application and recent effect of 125I seed brachytherapy treating malignant tumors of jaws and tissues around jaws. Methods: This research included 10 patients who had been treaded in Peking University Hospital of Stomatology since 2004. There were 5 males and 5 females aged from 34 to 92 years old( median age 66 ). All patients had pathology diagnosis before implantation. There were two malignant tumors of jaws, one central carcinoma of mandible, and one osteo-genic sarcoma. The malignant tumors of tissues around jaws included three gingival carcinomas, four carcinomas of the mouth floor, and one adenoid cystic carcinoma of hard palate, and 7 of them invaded periosteum of jaws. Ten patients were divided into three groups: the group of single radioactive seeds implantation, the group of radioactive seeds implantation after operation and the group of denture applicator plus radioactive seeds implantation after operation. Before the implantation all patients accepted CT examination. Then we made the plan through TPS. All patients received 125I radioactive seeds implantation under local anesthesia. At the meantime, patients of the third group took on the denture applicator. The patients accepted CT examination in one week, 2 months and 4 months after implantation, and then we made the implantation test through TPS. The test indexes included: target volume, D100, D90, D80, DVH and the index of fitness. The prescription dose of 10 patients was 60Gy-80Gy. the average number of seeds (0.5 or 0.7 mci per seed) was 22 per patient When patients came to interview, they were asked to answer a form about the quality of life. Results: Followed 3-22 months (median 8 month), malignant tumors of the first group three patients were released 60% in volume, and the pain was significantly released. Malignant tumors of the second and third group patients didn’ t relapse. 3/ 10 patients had ulcers in mucosa of oral cavity, and they cured without special treatment after 4-8 weeks. All patients didn’ t have other complications, and the quality of life was improved. Conclusions: 125I radioactive seed implantation brachytherapy is an effective and convenient method in combined therapy to treat malignant tumors of jaws and tissues around jaws, and it has the advantage of preserving jaw’ s functions and reducing complications. It is a feasible way to treat malignant tumors of gingival and hard palate through denture applicator with radioactive seeds.更多还原