超声引导放射性^(125)I粒子植入治疗头颈部复发肿瘤

Ultrasound guided implantation of radioactive ^(125)I seeds for treatment of recurrent head and neck carcinomas

目的:探讨超声引导下125I粒子植入治疗头颈部肿瘤复发的可行性及近期疗效。方法:选取2002年6月至2009年11月收治的29例既往接受过颈部外照射或颈清扫术联合外照射后再次局部或区域复发患者,局部麻醉,利用超声引导插植18 G粒子针,针间距1 cm,范围包括肿瘤靶区+外周0.5 cm;后退式植入125I粒子,粒子间距1 cm;中位植入粒子数27颗(范围3～61颗),粒子活度0.35～0.80 mCi(1.30×107～2.96×107Bq)。术后即刻或24 h内行CT扫描,层厚5 mm,将图像传送到计算机治疗计划系统进行质量验证。结果:随访3～42个月,中位随访时间8个月。术后剂量验证D90(90%靶区内体积接受的照射剂量)为90～160 Gy,中位剂量为130 Gy。1年局部控制率为53.1%,2年为34.8%,3年为17.4%,全组病例中位控制时间8个月(95%CI 2.8～21.1)。1年生存率54.1%,2年生存率27.5%,3年生存率27.5%,全组病例中位生存时间8个月(95%CI 7.6～18.3)。结论:超声引导下125I粒子植入治疗复发头颈部肿瘤是一种安全、有效、易操作的微创治疗方法,是较好的挽救治疗手段之一。

Objective： To evaluate the efficacy and the technological feasibility of B-ultrasound guided implantation of 125I seed for recurrent head and neck cancer.Methods： In the study,29 patients with local or regional recurrence of head and neck tumors after external beam radiotherapy alone,external beam radiotherapy combined neck dissection or chemotherapy were treated with 125I seed implantation guided by ultrasound under local anesthesia.The median number of seeds was 27（ranging from 3 to 61）,and the radioactive activity ranged from 0.35-0.8 mCi（1.30×107-2.96×10 7 Bq）.Postoperative quality evaluations were routinely obtained for all the patients.Results： The median follow-up was 8 months（ranging from 3 to 42 months）.The 1-,2-and 3-year local controls were 53.1%,34.8%,and 17.4%,respectively.The 1-,2-and 3-year survival rates were 54.1%,27.5%,and 27.5%,respectively.Conclusion：Ultrasound guided implantation of 125I seeds can play an important role in the salvage treatment of recurrence of head and neck cancer.This study shows B-ultrasound guided 125I seed implantation is one of the most efficient brachytherapies,which is easy to operate,least invasive and safe for low morbidity.