手术联合125I粒子治疗口腔颌面部腺样囊性癌的疗效与相关预后因素分析

目的:回顾总结北京大学口腔医院应用手术联合 ¹²⁵I放射性粒子治疗口腔颌面部腺样囊性癌的疗效,并分析相关预后因素。方法:75例原发性口腔颌面部腺样囊性癌患者,行原发灶扩大切除或部分切除,经治疗计划系统(treatment planning system,TPS)制定放射性粒子植入计划,于术中或术后植入放射性粒子,处方剂量60~120 Gy。患者定期随访,采用Kaplan-Meier法评估肿瘤控制及生存情况,并应用Cox回归分析对其相关预后因素进行分析。结果:75例患者3年、5年局部控制率分别为90.0%、78.8%,T₁~T₂患者分别为92.2%、82.0%,T₃~T₄患者均为82.6%。无瘤生存率为3年74.9%、5年54.3%。总生存率3年、5年分别为86.0%、79.6%,其中T₁~T₂患者均为91.3%,T₃~T₄患者分别为73.9%、59.7%。3年、5年无远处转移生存率分别为84.4%、76.7%,其中T₁~T₂患者分别为83.4%、79.6%,T₃~T₄患者分别为86.0%、67.8%。通过COX单因素分析及多因素分析,年龄是影响患者局部控制的预后因素,肿瘤分期及肿瘤部位为影响患者生存率的预后因素。结论: ¹²⁵I放射性粒子植入作为口腔颌面部腺样囊性癌术后辅助治疗可以获得较好的局部控制率、无瘤生存率及总生存率。高龄者易出现局部复发,肿瘤分期高及肿瘤位于鼻腔、鼻窦者生存率较低。

Study of surgery combined with 125I brachytherapy for adenoid cystic carcinoma of oral and maxillofacial region

Objective: To retrospectively analyze the results of treatment outcome by surgery combined with ¹²⁵I brachytherapy and correlative factors of adenoid cystic carcinoma (ACC). Methods: In the study, 75 patients with primary ACC of oral and maxillofacial region were treated by surgery combined with ¹²⁵I seeds brachytherapy. Radical resection or subtotal resection was applied for the tumor. The brachytherapy treatment planning system was used to create implant plans with the prescribed dose of 60 Gy to 120 Gy. The ¹²⁵I seeds were implanted intraoperatively or postoperatively. The regular follow-up was required. The Kaplan-Meier method was used to assess the tumor control rate and the patients’ survival rates. Meanwhile, the Cox regression analysis was used to find out the prognostic factors. Results: Local control rates at the end of 3 and 5 years were as follows: T₁-T₂, 92.2% and 82.0%; T₃-T₄, 82.6% and 82.6%; and overall, 90.0% and 78.8%. The disease-free survival rates were 74.9% and 54.3%, respectively. The overall survival rates for all the patients were 86.0% and 79.6%, respectively at the end of 3 and 5 years and were 91.3% and 91.3% for T₁-T₂ patients vs. 73.9% and 59.7% for T₃-T₄ patients. Distant metastasis-free survival rates at the end of 3 and 5 years were 84.4% and 76.7%, respectively. The distant metastasis-free survival rates at the end of 3 and 5 years were 83.4% and 79.6% with T₁-T₂ lesion compared with 86.0% and 67.8% with T₃-T₄ lesion. According to the COX univariate analysis and multivariate analysis, the risk of local recurrence would be raised by the age. Tumor stage and tumor site were the prognostic factors of the overall survival rates. Conclusion: ¹²⁵I brachytherapy conducted as an adjuvant therapy postoperatively of ACC of oral and maxillofacial region can acquire satisfactory local-regional control, distant metastasis-free survival, disease-free survival and overall survival. Tumors are prone to recur on the older patients. Patients having advanced tumor stage or tumor located in the nasal cavity or sinuses will suffer lower survival rates.