CT导向下放射性125Ⅰ粒子植入治疗头颈部复发和转移恶性肿瘤的近中期疗效

Short- to mid-term evaluation of CT-guided 125Ⅰ brachytherapy on recurrent or metastatic head and neck cancers

目的探讨125Ⅰ植入治疗复发／转移头颈部恶性肿瘤的可行性和近中期临床疗效。方法2003年1月—2008年5月，头颈部癌术后或放化疗后复发或转移35例，男23例、女12例，年龄39～71岁，中位年龄为56岁，在局部浸润麻醉下，CT、B超或腔内镜引导125Ⅰ粒子植入术，可评价病灶42个，病灶最大径2．0～9．0cm，平均值4．2cm。每个病灶植入粒子数目为12～70粒，中位粒子数33粒，粒子活度为29．6MBq，粒子间距0．5～1．0cm，肿瘤周边匹配剂量（MPD）为90—160Gy，随访观察局部控制率，总体生存率，疼痛缓解情况及并发症。结果随访4～40个月，4个月后评价42个局部病灶评价CR24／42，PR11／32，SD5／42，PD2／42，临床有效率83．3％（CR＋PR）；总体1年生存率88．4％，2年生存率72．4％，3年生存率45．2％，中位生存时间31个月；疼痛缓解率17／23（73．4％）。近期副反应轻微，远期副反应主要表现为植入粒子侧皮肤色素沉着4例，3例面颊部长期麻木感，口腔干涩2例，长期头痛伴感染1例，未见大出血、急性肺栓塞、局部脓肿、窦道、脑脊液漏等严重并发症。结论CT导向下放射性粒子植入头颈部复发和转移恶性肿瘤，并发症发生率低，患者生活质量改善明显，临床疗效确切，是一种简单、安全、有效的方法。

Objective to evaluate the short- and medium-term clinical effects of 125Ⅰ seed implantation on recurrent or metastatic head and neck cancers. Methods Thirty patients with recurrent or metastatic head and neck cancers after operation, radiotherapy, or chemotherapy, totaling 421 lesions 4.2 （2 -9） cm in diameter, 23 males and 12 females, aged 56 （39 -71 ） , underwent implantation of 12 -70 125Ⅰ seeds （on average 33 per person） under the guidance of CT, uhrasonography, or endoscopy with an interval of 1 cm between any 2 seeds with the radioactive activity per seed of 29. 6 MBq and matched peripheral dose of 90 - 160 Gy. Follow-up was conducted for 13 （4 -40） months to observe the local control rate, overall survival rate, pain relief, and clinical complications. Results Follow-up 4 months later showed that 24 of the 42 lesions obtained complete remission, 11 obtained partial remission, 5 no change, and 2 progress of disease, with a clinical response rate of 83.3% （ CR ＋ PR）. The overall 1-, 2-, and 3- year survival rates were 88.4%, 72. 4%, and 45.2% respectively with a median survival time of 31 months. The pain relief rate was 73.4% （17/23）. The long-term complications included hyperpigmentation at operative sites （ n = 4 ）, insensible feeling on lateral cheek （ n = 3 ）, dryness of oral cavity （ n = 2 ）, and headache combined with infection （n = 1 ）. Conclusion Relieving the pain, improving the life quality, CT guided radioactive 125Ⅰ seed implantation is a simple, safe, and effective method in treating recurrent or metastatic head and neck cancer with minimal damage and few complications.