外科手术联合放射性粒子^(125)I植入治疗晚期头颈部恶性肿瘤

Application of ^(125)I seeds brachytherapy in advanced head and neck malignant tumor combined with surgery

目的探讨~125Ⅰ放射性粒子对晚期头颈恶性肿瘤的综合治疗效果,评估对于手术切除不能保证可靠安全缘的病例,防止局部复发的效果。方法放疗后复发的喉癌伴有双侧颈部淋巴结转移,舌癌伴有颈部淋巴结转移,复发的上颌窦癌等,在进行根治手术后,术区植入~125Ⅰ放射性粒子。结果除1例舌癌患者术后6个月复发外,其余病例术后随访24～32个月,在随访期间肿瘤均未复发和转移。所有患者术后未发现因放射性粒子原因出现的切口感染、出血、切口不愈合等并发症,未发生粒子脱落。结论放射性粒子~125Ⅰ植入疗法是治疗头颈恶性肿瘤的有效方法之一,为肿瘤的综合治疗增添了新的治疗手段,尤其是手术后复发、放疗后复发以及不能彻底切除的晚期恶性肿瘤的有效方法之一;同时对于手术切除不能保证可靠安全缘的病例,也是防止局部复发的有效手段。

OBJECTIVE To evaluate the effectiveness of ^125I seeds brachytherapy in advanced head and neck malignant tumor. METHODS Twelve patients with post-radiotherapy recurred laryngeal cancer with bilateral cervical lymph node metastasis, tongue cancer with bilateral cervical lymph node metastasis or recurred maxillary sinus cancer and so on were operated radically, and ^125I seeds were implanted in wound area during operation. RESULTS With a follow-up of 24 to 32 months, no tumor recurred in 11 patients, and only one patient with tongue cancer recurred at 6 month after operation. No local infection, acute radioactive lesion, vessel broken or seeds migration happened. CONCLUSION The ^125I brachytherapy can be used as one of the comprehensive treatment method in advanced head and neck malignant tumors, especially in the recurred tumors after operation or radiotherapy or in the cancer which can not be radically removed. It＇s also an effective method to improve local control in the subset of patients with doubtful positive margins.