I^(125)植入联合替吉奥辅助化疗治疗头颈癌的临床应用

Clinical Application of I^(125)-seed Implantation Combined with Gimeracil and Oteracil Capsules Adjuvant Chemotherapy in the Treatment of Head and Neck Cancer

目的探讨I125放射性粒子组织间植入联合替吉奥辅助化疗治疗头颈癌的疗效.方法选择2008年10月至2010年10月在昆明医学院第三附属医院头颈外科就诊的头颈癌患者40例,病理类型为:鳞状细胞癌26例,低分化腺癌14例;按解剖部位分为:下咽癌17例,上颌窦癌15例,口腔癌4例;颈转移癌4例.所有患者均因全身疾病或局部晚期而不能手术治疗,予I125放射性粒子植入,匹配周缘剂量(matched peripheral dose,MPD)为90～110 Gy,随机将患者分为2组,实验组术后联合替吉奥辅助化疗80 mg/m22个周期.对患者进行随访,分析急慢性放射性损伤、局部控制率和生存情况.结果实验组患者中肿瘤完全缓解13例(65%),部分缓解5例(25%),无效2例(10%),有效率为90%.术后随访42个月,失访1例,1 a生存率80.0%,2 a生存率48.75%,3 a生存率13.0%,中位生存期16个月.主要并发症为放射性口腔粘膜炎和局部出血.结论 I125粒子植入联合替吉奥辅助化疗对于有手术禁忌或无法切除的头颈癌近期疗效好,患者生存率满意,并发症少.

Objective To investigate the effect of combined I125-seed implantation and gimeracil and oteracil capsules adjuvant chemotherapy on head and neck cancer.Methods From Octorber 2008 to Octorber 2010,40 patients with head or neck cancer were selected in our hospital.Pathological types of the head or neck cancer cases were：26 cases of squamous cell carcinoma and 14 cases of poorly differentiated adenocarcinoma According to anatomical parts,the head or neck cancer cases were divided into：7 cases with hypopharyngeal Carcinoma,5 cases with maxillary sinus Carcinoma,4 cases with oral cancer;4 cases with cervical metastatic carcinoma.All patients could not receive surgery due to systemic disease or locally advanced cancer,and they were given a I125-seed implantation,the matched peripheral dose was 90～110 Gy.All patients were given two-cycle of postoperative adjuvant chemotherapy with 80 mg/m2 of gimeracil and oteracil capsules.The patients were followed up,and the acute and chronic radiation injury,local control and survival of patients were analyzed.Results In patients with cancer,complete remission was found in 13 cases（65%）,partial remission in 5 cases（25%）,invalid in 2 cases（10%）,and the effective rate was 90%.Postoperative follow-up for 42 months,1 case was lost in the follow-up,the 1-year,2-year and 3-year survival rate was 80.0%,48.75% and 13.0%,respectively.The median survival period was 16 months.Primary complications were oral mucositis and local hemorrhage.Conclusion I125-seed implantation combined with gimeracil and oteracil capsules adjuvant chemotherapy has good therapeutic effect on head and neck cancer with surgical resection taboo,with satisfying survival rate in patients and fewer complications.