^(125)I放射粒子植入治疗肿瘤颈部淋巴结转移

^(125)I Particles Brachytherapy for Advanced Cervical Lymph Metastases Preliminary Report of Nine Cases

目的探讨125I放射粒子植入治疗肿瘤颈部淋巴结转移的短期疗效评估。资料与方法9例中,食管来源肿瘤2例,乳腺来源肿瘤2例,甲状腺来源肿瘤2例,肺来源肿瘤3例。每例颈部转移淋巴结3个以下,最大淋巴结直径1.5～6.5cm,平均4.2cm。采用计算机三维肿瘤治疗计划系统(TPS);Philips MX 8000螺旋CT;转盘式全封闭防辐射连击式植入器,18G粒子植入针。125I放射粒子半衰期为59.43d,平均能量27.4keV,组织穿透1.7cm,初始能率7cGy/h,共211粒。CT自C1水平向下扫描至T1水平,层厚5mm,利用TPS计算布源后,在CT定位下植入125I放射粒子。术后2个月复查CT及再次穿刺活检。结果治疗后2个月复查CT进行比较,9例中完全缓解(CR)0例,部分缓解(PR)2例,无变化(NC)6例,进展(PD)1例,总有效率为88.9%;2个月内无死亡病例;局部皮肤红肿及破溃1例,经换药后好转;无一例发生血管栓塞。术前与术后2个月行淋巴结活检,病理明确病灶内肿瘤活性降低。结论CT定位引导下能够准确地植入125I放射粒子并有效地控制肿瘤转移灶的生长,创伤小,并发症少,近期效果好,具有一定的临床应用价值。

Objective To assess the short time efficacy of 125I seeds implantation for patients with cervical lymph nodes metastasis. Materials and Methods Nine patients （ 1 male and 8 female; 48-77 years old and median 58） with cervical lymph nodes metastasis were treated with ^125Iseeds implantation. The primary cancers derived from esophagus （2 eases）, breast （2 cases）, thyroid （2 cases） and lung （3 cases）. The number of metastasized cervical lymph nodes was no more than 3, the mean diameter of lymph node was 4.2 cm（ range, 1.5-6.5 cm）. The half life of ^125I seed is 59.6 days. The seed strengths ranged from 27KeV to 35KeV with the primary strength of 7cGY/h. Totally 211 seeds were implanted in this study. We employed computer TPS system to calculate seeds distribution. Philips MX8000 spiral CT to guide the procedure and 18G needles to puncture the affected cervical lymph nodes. All thepatients have CT scan and lymph nodes biopsy to evaluate the outcomes 2 month after implantation. Results In 9 cases, there was 0 complete relief （CR） case; 2 partial relief （PR） cases; 6 no change （NC） and 1 progression （PD） cases. The total effective power was 88.9%. Neither a case died nor a case suffered blood vessels embolism during follow up for 2 months . Only one case of swelling and ulcer at local skin recovered after symptomatic treatment. Conclusion By CT image Guidance, accurate ^125I implantation can be achieved. ^125I radioactive particle should inhibit the growth of metastasized lymph nodes. Minimal invasion, low complication rate and good short time efficacy indicate the clinic value of ^125I seeds brachytherapy for cervical lymph nodes metastasis.