放射性125I粒子植入治疗头颈部肿瘤

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例采用全身麻醉，在CT引导下行^125I粒子植入术；36例采用局部麻醉，行超声引导下^125I粒子植入术。粒子针平行排列，间距1～1．5cm，原发肿瘤植入靶体积影像学边界外放lcm，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）90～145Gy，每颗粒子活度0．40～0．70mCi，每个病灶植入3～84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24h拍头颈正侧位平片或CT，行质量验证。术后24～48h拍胸部x线片了解有无粒子移位或游走。结果 随访3～33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例颈部淋巴结转移的患者经粒子治疗后完全缓解，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，尤其是为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。

Implantation of iodine-125 seed for head and neck carcinoma

Objective To investigate the technological feasibility,efficacy and morbidity of ~(125)I-seed implantation for head and neck cancer. Methods Forty patients with head and neck cancer were treated with ~(125)I-seed intersitial brachytherapy guided by ultrasound or CT.Among them thirty-six patients were performed under local anesthesia and four were under general anesthesia.Thirty-six patients were treated with ~(125)I-seed implantation under ultrasound guidance and four cases under CT guidance.Seed needles were implanted in parallel with each other,1-1.5 cm apart.Mick applicator was used to each needle to implant seed.The radioactive activity ranged 0.40-0.70 mCi,and the matched peripheral doses were 90-145 Gy.The mean number of ~(125)I-seed was 3-84.Five cases received external beam irradiation one week after seed implantation,and the total doses were 45-50 Gy(200 cGy/f).All the cases were examined by X-ray or CT after implantation for quality evaluation and by routine chest X ray within twenty-four to forty-eight hours after seed implantation. Results These patients were followed-up for 3-33 months.In 10 tongue carcinoma patients,complete response was shown in 3 cases,partial response in three cases,no change in three cases and progressive disease in one case.The local control rate was 60%,the median survival time was 11 monthes,and the one-year and two year survival rates were 87.50% and 35%,respectively.In 14 patients with recurrent cancer of head and neck the local control rate was 76.47%,the one-year and two-year survival rates were 66.08% and 24%,respectively,and the median survival time was 9 months.In 16 patients with metastatic cancer of head and neck the local control rate was 95.23%,the one-year and two-year survival rates were 54.55% and 32.73%,and the median survival time was 9 months.One seed migrated to the maxilla and loss of seeds happened in two cases,but there was no clinically related mobidity. Conclusion ~(125)I-seed implantation for recurrent or metastatic head and neck cancer under guidance of ultrasound or CT is safe,minimal invasive,with low morbidity and high efficacy,especially for recurrent and matastatic cancer of head and neck after surgery or radiotherapy.