术中瘤床植入放射性^(125)I粒子治疗颈部转移性鳞癌

Interstitial radiotherapy with intraoperative iodine-125 seed(^(125)I seed)planting in tumor bed for metastatic cervical squamous cell carcinoma

目的探讨术中瘤床内植入^(125)I粒子治疗晚期颈部转移性鳞癌的疗效。方法 2006年10月~2012年12月共用^(125)I放射性粒子治疗颈部转移性鳞癌67例,男49例,女18例;年龄42~79岁,中位年龄47岁。其中口腔癌术后颈部转移癌26例,喉癌及下咽癌术后颈部转移癌16例,鼻咽癌放疗后3个月颈部残留转移癌11例,放疗后复发的颈部转移癌14例。以术前治疗计划系统(treatment planning system,TPS)计划的粒子数及进针方向做术中置放粒子位置参考,在瘤床中^(125)I植入放射性粒子,术后CT复查,了解粒子分布状况。置放的粒子活度为1.85×107Bq^2.96×107Bq,植入粒子数16~34粒不等,其中术后补充外放射治疗21例,外放射剂量25~45 Gy。结果对瘤床植入^(125)I粒子治疗的患者无瘤生存21例,复发并死亡25例。3年生存率54.4%,5年生存率44.6%,无瘤生存率31.3%。结论^(125)I放射性粒子对颈部转移癌的瘤床残留或亚临床病灶起到明显的杀灭作用;患者体内携^(125)I粒子持续长时间低剂量近距离组织间放疗,可以居家治疗,无需住院。

Objective To evaluate the effectiveness of brachytherapy with intraoperative iodine-125 seed（125I seed）planting in tumor bed for metastatic cervical squamous cell carcinoma. Methods During Oct. 2006 to Dec. 2012,67 patients suffering from metastatic cervical squamous cell carcinoma were treated with iodine-125 seed of amount ranged from16 to 34 grains as part of the protocol for cervical squamous cell carcinoma. Among them,49 were male and 18 were female with age ranged from 42 to 79 years old（ median age = 47）. Their initial tumors included oral carcinoma（ n = 26）,laryngeal and hypopharyngeal carcinoma（ n = 16）,nasopharyngeal carcinoma（ n = 11） and cervical squamous cell carcinoma（ n = 14）. According the preoperative treatment planning system（ TPS）,the way and numbers of iodine-125 seed to plant in tumor bed was designed. Postoperative CT was then performed to all cases to detect the distribution of iodine-125 seeds. The activity of iodine-125 seeds ranged from 1. 85 × 10^7 Bq to 2. 96 × 10^7 Bq. After iodine-125 seed implantation,21 cases underwent radiotherapy of 25 to 45 Gy. Results Of all the 67 cases,21 cases survived with tumor free,while 25 cases were recrudescent and deceased. Their 3-year survival rate,5-year survival rate and tumor-free survival rate was 54. 4%,44. 6%,and 31. 3% respectively. Conclusion The intraoperative125 I seed brachytherapy is effective in exterminating residual and subclinical lesions. Relative long-time and low-dose of125 I brachytherapy will allow patients to have home treatment without hospitalization.