MRI导航下125I治疗颌面部腺源性恶性肿瘤效果初探

MRI interstitial 125I seed implantation treatment for oral and maxillofacial adenogenic malignant tumor

目的 探讨MRI导航下125I粒子治疗颌面部腺源性恶性肿瘤的临床效果.方法 39例口腔颌面部腺源性恶性肿瘤患者,术后1周行125I粒子组织内植入近距离照射治疗.粒子植入前行MRI扫描,制定植入计划.术中按计划先行定位针植入,导航下调整定位针位置和方向,将125I粒子依次植入靶区,并实时评估植入粒子是否与术前设计位点相符.植入后1周内和2个月行CT检查,行靶区剂量学分析与验证.术后定期复诊检查肿瘤有无复发、淋巴引流区淋巴结是否肿大以及是否远处转移.结果 全部患者手术过程顺利.术后CT未见粒子游走.术后验证粒子植入位置与术前设计一致.39例患者中7例局部肿瘤复发,局部控制率为82％（32/39）;1例肺部转移,1例同侧颈部淋巴转移.所有患者均未出现严重影响生命质量的并发症,未见粒子游走.结论 MRI导航下125I粒子植入治疗颌面部腺源性恶性肿瘤是一种精确的治疗方法,可有效降低术后并发症和复发率.

Objective To assess the therapeutic efficacy of MRI guided interstitial 125I seed implantation in the treatment of oral and maxillofacial adenogenic malignant tumor Methods A total of 39 patients with oral and maxillofacial adenogenic malignant tumors received interstitial 125I implantation treatment one week postoperatively.Before implantation,MRI scanning was performed and implantation plan of 125I was designed with the aid of treating plan system.During the implantation,positioning pin was firstly implanted and then its position and direction were adjusted according to navigation.Next,125I was delivered into the target region.Real-time assessment was required to find if the sites of implantation corresponded with that of preoperative design.One week and two months after implantation,CT scanning and dosimetric analysis were performed.All the patients needed regular reexamination to observe if there was recurrence of tumor,lymphadenectasis in lymph draining region and distant metastasis.Results All the procedures of implantation were successful.Post-operative CT showed no seed migration and the location of implanted 125I was exact as designed.Among the 39 patients,7 cases suffered from tumor recurrence,with local control rate of 82％（32/29）.One got pulmonary metastasis,and one had ipsilateral lymphadenectasis.No serious complications affected life quality,and no seeds migration was observed.Conclusions MRIguided implanting of 125I is an accurate way to treat oral and maxillofacial adenogenic malignant tumors,which could effectively decrease postoperative complications and tumor recurrence rate.