CT引导下^125I粒子植入治疗放疗后复发头颈部肿瘤的临床效果

Clinical efficacy of CT-guided iodine-125 seed implantation for recurrent head and neck carcinoma after external beam radiotherapyClinical efficacy of CT-guided iodine-I25 seed implantation for recurrent head and neck carcinoma after external beam radiotherapy

目的 分析125 I粒子植入治疗放疗后复发头颈部肿瘤的疗效及安全性.方法 纳入自2007-2015年于我科接受CT引导下125 I粒子植入治疗的头颈部肿瘤放疗后复发患者数据,共101例,以往接受外照射中位积累剂量66 Gy.粒子植入后剂量（D90）中位数117 Gy.Kaplan-Meier法计算生存率,Logrank检验和单因素分析,Cox模型多因素分析.结果 中位随防12.2个月.患者5年局部无进展生存率为26.6％,5年总生存率为15.5％.单因素分析显示与局控相关因素为年龄、病理类型、植入部位、病灶体积 、D90、近期疗效（P均〈0.05）,与生存相关因素为KPS、病灶体积 、D90及近期疗效（P均〈0.05）.多因素分析显示病理类型、病灶体积 、D90、近期疗效为与局控相关的影响因素（P=0.000、0.002、0.003、0.014）.不良反应方面,皮肤/黏膜破溃25.7％,疼痛13.9％.尚未发现不良反应与剂量的相关性.结论 125 I粒子植入治疗放疗后复发头颈部肿瘤有良好的有效性及安全性,非鳞癌、病灶体积小 、D90高预示较好的局控.

 Objective To evaluate the clinical efficacy and safety of CT-guided 125 I seed implantation in the treatment of recurrent head and neck tumors after radiotherapy. Methods Clinical data of 101 patients who received CT-guided radioactive 125 I seed implantation for recurrent head and neck cancer after radiotherapy from 2007 to 2015 were retrospectively analyzed. The median accumulated dose of external radiotherapy was 66 Gy and the median dose after seed implantation （D90） was 117 Gy. The local progression-free survival and overall survival were analyzed by Kaplan-Meier method. Univariate analysis was performed by log-rank test and multivariate analysis was conducted by using Cox regression model. Results The median follow-up time was 12. 2 months. The 5-year local progression-free survival rate was 26. 6%.The 5-year overall survival rate was 15. 5%. Univariate analysis demonstrated that age,pathological type,implantation site,lesion volume,D90 and short-term efficacy were correlated with local control,and KPS score,lesion volume ,D90,and short-term efficacy were associated with survival （all P〈0. 05）. Multivariate analysis revealed that pathological type,lesion volume ,D90 and short-term efficacy were independent factors related to local control （P= 0. 000, 0. 002,0. 003 and 0. 014）.In terms of the adverse events,skin/ mucosal ulceration was observed in 25. 7% and pain occurred in 13. 9% of all patients. No correlation was noted between the adverse events and dose.Conclusions CT-guided radioactive 125 I seed implantation is an efficacious and safe treatment of recurrent head and neck tumors after radiotherapy. Non-squamous carcinoma,small lesion volume and high dose （D90） indicate excellent local control.