腮腺癌术后 125I 粒子组织间近距离治疗靶区确定方法的探讨

目的 探讨腮腺癌术后¹²⁵I粒子组织间近距离治疗靶区的确定方法。方法 2002年10月至2006年11月北京大学口腔医院的31例腮腺癌患者,男女比例14 ∶17,平均年龄38.2岁,肿瘤有包膜外浸润并与面神经关系密切(黏连或神经侵犯),采用保留面神经的肿瘤及腺体切除术,术后行¹²⁵I粒子组织间近距离治疗,匹配周缘剂量60 Gy。治疗前后行薄层螺旋CT扫描以制定治疗计划和质量验证,以腮腺周围骨性结构和肌组织为参照确定计划靶区和临床靶区,并比较治疗前后靶体积、靶区D₉₀值的差异,同时计算粒子植入后颌骨、中耳D₉₀值以及脊髓最大接受剂量。结果 ¹²⁵I粒子治疗前后靶体积、靶区D₉₀值差异无统计学意义,粒子植入后靶区D₉₀值均大于匹配周缘剂量。本组病例随访时间3~7年,未见肿瘤复发。结论 根据目前随访结果,采用本方法确定¹²⁵I粒子腮腺区组织间近距离治疗靶区,临床治疗效果满意。

Target volume determination of postoperative 125I seeds interstitial brachytherapy in parotid gland carcinoma

Objective To explore the method of target volume determination of postoperative ¹²⁵I seeds interstitial brachytherapy in parotid gland carcinoma. Methods A total of 31 cases(14 males and 17 famales) with primary parotid carcinoma who were treated in Peking University Hospital of Stomatology from Oct 2002 to Nov 2006. The patients' average age was 38.2 years. All patients underwent tumor resection and postoperative ¹²⁵I seeds interstitial brachytherapy with 60 Gy matched peripheral dose. The spiral CT was performed for treatment plan and quality verification before and after the brachytherapy. The bone and muscle landmarks surrounding parotid were selected as reference for target volume determination. D₉₀ of target volume and dose of organs at risk were calculated, while the target volume and D₉₀ of target volume of verification were compared with that of treatment plan through quality verification. Results The target volume or D₉₀ of target volume before and after treatment was not statistically different. D₉₀ of target volume was more than 60 Gy. During 3-7 years of follow-up, all patients had no recurrence. ConclusionsAccording to the follow-up results, the method used for target volume determination in this paper might be satisfied.