^125Ⅰ放射性粒子近距离放射治疗口腔癌的初步临床应用

The initial experience of ^125Ⅰ seeds brachytherapy for patients with oral carcinoma

目的探讨放射性^125Ⅰ粒子组织间置入及粒子敷贴治疗口腔癌的操作方法和临床效果。方法18例口腔癌患者，均经脱落细胞学或组织病理学证实，其中舌癌12例、牙龈癌6例，溃疡灶20个，平均直径（2．3±0．7）cm，颈部转移淋巴结10个，平均直径（2．8±1．7）cm。根据病变情况采用^125Ⅰ粒子组织间置入联合粒子敷贴表面近距离放射治疗或单纯采用粒子敷贴表面近距离放射治疗；颈部转移淋巴结行^125Ⅰ粒子组织间置入。首次治疗后1、3、6个月复查，观察溃疡面及颈部淋巴结的大小变化，应用配对设计t检验对溃疡面的大小进行统计学分析。结果本组患者粒子置入均顺利完成，分布满意，共置入粒子8～29颗／例，平均15颗／例。治疗后1、3、6个月复查，溃疡病灶平均长径分别为：（2．1±0．6）cm（t=3．559，P〈0．01）、（1．7±0．5）cm（t=7．609，P〈0．01）、（0．7±0．6）cm（t=11．508，P〈0．01）。颈部淋巴结均有不同程度缩小，PET—CT显示病灶代谢活性较术前明显减低。治疗后6个月，8例患者溃疡面愈合，1例颈部转移淋巴结复发，行第2次置入。本组患者随访7～28个月，随访期内所有患者均存活。结论放射性^125Ⅰ粒子组织间置入及粒子敷贴是治疗口腔癌安全、有效的方法，具有一定的临床应用价值。

Objective To evaluate the efficacy of ^125Ⅰ radioactive seeds implantation and ^125Ⅰ plaque brachytherapy for oral carcinoma. Methods Eighteen patients with oral carcinoma confirmed by cytology or histopathology were included in this study, Twelve patients with tongue cancer and six patients with gingival carcinoma, there were 20 ulcerative lesions and 10 metastatic cervical lymph nodes. The mean diameter is （2. 3 ± 0.7 ） cm and （2. 8 ± 1.7 ） cm respectively. The patients were treated with both interstitial implantation of ^125Ⅰ seeds and ^125Ⅰ plaque brachytherapy or with ^125Ⅰ plaque brachytherapy only according to patient＇s individual conditions. The metastatic cervical lymph nodes were treated with CT-guided interstitial implantation of ^125Ⅰ seeds. The sizes of ulcerative lesions and lymph nodes were observed at 1,3,6 months following treatment, and statistical analysis of the sizes of ulcerative lesions were evaluated by paired t-test. Results After 1,3,6 months follow-up, The mean diameters of ulcerative lesions were （ 2. 1 ± 0. 6） cm （t=3.559,P〈0.01）,（1.7±0.5）cm（t=7.609,P〈0.01）,（0.7±0.6）cm（t=11. 508,P〈0.01）, the cervical lymph nodes showed reduced size. Furthermore, PET-CT images showed a significant decrease in the metabolic activity of treated tumor. After six months, the focus of infection were healing in 8 patients, the cervical lymph nodes of one patient relapsed after ^125Ⅰ implantation again. Patients were followed for 7 to 28 months, all patients were still alive. Conclusion Interstitial ^125Ⅰ radioactive seeds implantation and ^125Ⅰ plaque brachytherapy provide an effective, safe treatment for oral cancer.