放射性125I粒子治疗唾液腺腺源性癌局部区域失败因素分析

目的 总结放射性¹²⁵I粒子治疗唾液腺腺源性癌局部与区域治疗失败的发生规律，分析影响其局部与区域治疗失败的危险因素。方法 按照病例纳入标准，回顾性分析2001年10月至2012年8月，就诊于北京大学口腔医学院口腔颌面外科经放射性¹²⁵I粒子治疗的唾液腺腺源性癌患者，并对影响局部区域控制的因素（年龄、性别、病理学分型、原发或复发、TNM分期、部位、放疗史、治疗情况、周缘剂量等）进行统计学分析。结果 经放射性¹²⁵I粒子治疗的唾液癌患者449例，局部与区域治疗失败共94例，其中局部病理区域均治疗失败者6例，单独局部治疗失败者77例，单独区域治疗失败者11例。局部与区域治疗失败率为20.9%，局部区域治疗失败的复发时间为1.2~117.6个月，平均复发时间是16.2个月。多因素分析显示，手术、放疗、周缘剂量是经放射性¹²⁵I粒子治疗唾液腺癌的局部区域失败的保护因素（OR=0.458、0.297、0.982，P<0.05）；年龄、分期是经放射性¹²⁵I粒子治疗唾液腺癌的局部区域失败的危险因素（OR=1.250、1.483，P<0.05）。结论 经放射性¹²⁵I粒子治疗的唾液癌患者，有20.9%局部区域治疗失败率。手术、放疗、周缘剂量是保护因素，年龄、分期是危险因素。

Clinical investigation on local and regional failure factors of salivary gland carcinoma treated by 125I seeds

Objective To summarize clinical features of local and regional failure of salivary gland carcinoma treating by ¹²⁵I seed, and evaluate the clinical and histologic risk factors for its development.Methods Patients with salivary gland carcinoma treated by ¹²⁵I seeds between Oct 2001 and Aug 2012 were analyzed retrospectively. The risk factors were analyzed statistically, including age, gender, tumor site, TNM stage, histological differentiation, radiotherapy, treatment, matched peripheral dose and primary or recurrent tumor. Results Ninety-four of 449 patients with salivary gland carcinoma treated by ¹²⁵I seeds developed local and/or regional area recurrence. Of these, six patients failed in both local and regional area, 77 patients failed in local area and eleven patients failed in regional area. The local and regional failure rate was 20.9%. The result of multivariate analysis showed that surgery, radiotherapy and matched peripheral dose were the protective factors(OR=0.458, 0.297, 0.982,P<0.05), while age and TNM stage were the risk factors(OR=1.250, 1.483, P<0.05). Conclusions The local and regional failure rate was 20.9%. Surgery, radiotherapy and matched peripheral dose were the protective factors; age and TNM stage were the risk factors.