CT引导下^(125)I粒子组织间放疗在口腔癌颈淋巴结转移的初步应用

CT-guided transcutaneous interstitial implantation of ^(125)I seeds for cervical lymph nodes metastasis in oral carcinoma

目的初步总结放射性125I粒子在CT引导下经皮穿刺组织间植入治疗口腔癌颈淋巴结转移操作方法、近期疗效和副反应。方法10例口腔癌颈淋巴结转移患者采用CT引导125I粒子组织间植入放射治疗,植入前采集影像资料,设计靶区,通过TPS设计治疗计划,通过CT引导依治疗计划经皮穿刺植入125I粒子,植入术后即刻及2月验证125I粒子分布及靶区剂量变化。随访观察疗效及副反应。结果本组患者植入顺利,粒子分布满意,靶区剂量符合设计要求,随访12～28个月,平均19个月,手术+粒子放疗9例靶区内未见复发,余1例单纯植入治疗,转移淋巴结缩小50%以上。5例患者局部皮肤充血反应3例患者出现咽痛均未作特殊处理,本组病例未见严重放射性损伤。结论放射性125I粒子在CT引导下经皮穿刺组织间植入治疗口腔癌颈淋巴结转移具有操作精确、安全可靠,对控制复发及颈淋巴结转移近期效果满意。

Objective To evaluate the technic,result and complications of interstitial implantation of I - 125 seeds for cervical lymph nodes metastasis in oral carcinoma guided by CT aided with three dimensional treatment planning system （TPS）. Methods Ten patients with cervical lymph nodes metastasis in oral carcinoma were treated with interstitial implantation of 125I seeds guided by CT with TPS monitored immediately by CT after implantation. Another CT scanning was repeated after 2 months. Results 10 cases were followed up for 12 - 28 months with an average of 19 months. 1 patient with cervical recurrence of oral carcinoma was treated only by seed implantation,the tumor size reduced 〉50%. In the other 9 patients who were implanted after operation, no recurrence was seen in the target area. There were no extreme raditherapeutic side effects except for skin hyperemia occurred in 5 patients and angina occurred in 3 patients. Conclusion CT guided transcutaneous interstitial implantation of 1251 seeds is an accurate, safe and valid procedure.