超声引导放射性^(125)I粒子植入治疗头颈部复发或转移癌

Ultrasound guided ^(125)I seed interstitial brachytherapy for recurrent or metastatic head and neck cancer

目的探讨超声引导下放射性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。方法选择30例头颈部癌术后或放疗后复发或转移患者。局部浸润麻醉,超声引导下125I粒子植入术。粒子针平行排列,间距1~1.5cm,原发肿瘤边缘外放1cm,转移瘤为影像学边界。利用Mick枪后退式植入粒子,粒子间距1cm。肿瘤周边匹配剂量(matched peripheral dose,MPD)90~160Gy,每颗粒子活度0.40~0.70mCi,每个病灶植入3~84颗粒子,中位粒子数24颗。10例粒子剂量低于130Gy者,术后1周加外放疗,每次2Gy,总剂量45~50Gy。术后24h拍头颈正侧位和胸部X线片,了解粒子移位或游走。结果随访3~33个月,中位数12个月。全组局部控制率为93.3%(28/30),2例因局部复发死亡。1年和2年生存率分别为51.7%和19.4%,中位生存期12个月。无严重皮肤反应。结论放射性125I粒子植入治疗头颈部癌疗效确切,尤其是对那些手术后或放疗复发患者提供了一种安全和微创的治疗手段。

Objective To investigate the technological feasibility and short-term efficacy of ^125Ⅰ seeds implantation in head and neck cancer. Methods Thirty patients with head and neck recurrent cancer were treated with ^125Ⅰ seeds interstitial brachytherapy. The operation was performed under local anesthesia and the ^125Ⅰ seeds were implanted under the guidance of ultrasonography. The seed needles were implanted parallelly to each other, at 1 - 1.5 cm apart. The Mick applicator was used to implant seed at 1 cm interval. The radioactive activity per seed ranged 0.40 - 0.70 mCi, and the matched peripheral dose （MPD） was 90 - 160 Gy. The number of ^125Ⅰ seed implanted per lesion was 3 - 84 （ median, 24）. Ten patients with a seed radioactive dose 〈 130 Gy received external beam radiation therapy 1 week after seed implantation, with a total dose of 45 - 50 Gy at 2 Gy each fraction. Postoperative head, neck and chest X-ray examinations were conducted at 24 hours after seed implantation for monitoring seed dislodgment or migration. Results Follow-up observations for 3 - 33 months （ median, 12 months） showed a local control rate of 93.3% （28/30）. Two patients died of local recurrence. The 1- and 2-year survival rates were 51.7% and 19.4% , respectively. The median survival time was 12 months. No severe skin complications was found. Conclusions ^125Ⅰ seed implantation for recurrent or metastatic head and neck cancer under the guidance of ultrasound is safe, minimally invasive, and effective, especially for recurrent and metastatic cancer of head and neck after surgery or radiotherapy.