^125I粒子植入放疗在儿童眼眶横纹肌肉瘤综合治疗中的应用

Application of Radioactive ^125I Seeds Implantation Brachytherapy in the Comprehensive Treatment of Pediatric Orbital Rhabdomyosarcoma

目的:观察 ^125I粒子植入放疗在儿童眼眶横纹肌肉瘤综合治疗中的效果与并发症。 方法:回顾性系列病例研究。收集2013年1月至2017年1月在郑州大学第一附属医院收治的8例儿童眼眶横纹肌肉瘤患儿的临床资料。所有患儿均经手术切除和病理检查确诊,根据WHO制定的病理组织学分型标准分为胚胎型6例,腺泡型2例。根据美国横纹肌肉瘤研究协作组(IRSG)分期标准分为Ⅰ期1例,Ⅱ期3例,Ⅲ期4例。所有患儿均在儿科规范化疗,计划在肿瘤切除术后1个月行 ^125I粒子植入放疗。随访项目包括肿瘤控制情况和放疗并发症情况。 结果:4例手术中肉眼切除干净,另4例因边界欠清晰未切除干净。7例患者按照各自预定方案完成了化疗,1例未完成化疗并放弃后续治疗。完成综合性治疗的7例患儿4年无瘤生存率为100%,中位随访时间48(37~66)个月。未完成综合治疗方案者1例,因脑转移死亡(眼眶部位稳定控制)。穿刺并发症:1例穿刺道出血。放疗并发症:早期(≤6个月)有角膜刺激征5例,睫毛眉毛脱失5例,局部皮肤色素沉着2例;晚期(>6个月)有视力下降5例,眼表新生血管性病变5例,局部皮肤色素沉着5例,皮下组织萎缩、硬化4例,角膜刺激征3例,睫毛眉毛脱失2例,新生血管性青光眼2例(其中角膜溃疡、穿孔并摘除眼球1例)。所有患儿均无眼眶及面骨发育异常,存活的7例患儿中有6例完整保留眼球,3例视力无影响。结论:包含 ^125I粒子植入内照射的综合治疗可较好地治疗儿童局限于眼眶内的横纹肌肉瘤,但粒子特有的并发症需要进一步观察。

Objective:To observe the effects and complications of radioactive ^125I seeds implantation brachytherapy in the comprehensive treatment of pediatric orbital rhabdomyosarcoma.Methods:This was a retrospective case series study.Eight pediatric cases with orbital rhabdomyosarcoma were treated and followed up from January 2013 to January 2017 in the First Affiliated Hospital of Zhengzhou University.All pediatric patients were treated by surgery,and were diagnosed by pathological examination.There were 6 cases with the embryonal type and 2 cases with the acinar type according to the histopathological classification standard developed by WHO.Based on the Intergroup Rhabdomyosarcoma Study Group(IRSG)stages:1 case was in stageⅠ,3 cases were in stageⅡ,and 4 cases were in stageⅢ.All children received standard chemotherapy in pediatrics,and radioactive ^125I seeds implantation brachytherapy was planned 1 month after resection.The curative effects and radiation complications were observed.Results:The tumors of 4 patients were completely and cleanly removed in the surgeries,and the others were not.Seven cases completed the comprehensive treatments.The 4-year tumor-free survival rate was 100%,except for 1 patient who did not complete the original chemotherapy plan.This patient eventually died due to brain metastases even though the orbital area was controlled.Follow-up was conducted with a median follow-up time of 48 months(37 to 66 months).Puncture complication:There was 1 case with a puncture hemorrhage.The short-term complications of radiotherapy(less than 6 months):There were 5 cases with irritating corneal symptoms and eyelashes and eyebrows missing,and 2 cases with local skin pigmentation.The long-term complications of radiotherapy(after 6 months):There were 5 cases with local skin pigmentation,5 cases with ocular surface neovascularization and visual loss,4 cases with subcutaneous atrophy and sclerosis,3 cases with corneal irritating symptoms,2 cases with eyelashes and eyebrows missing,and 2 cases with neovascular glaucoma.The eyeball of 1 patient was removed because of corneal ulcer and perforation.All of the pediatric patients had no abnormalities in the orbital or facial bones.The eyeballs remained intact in 6 cases among the 7 surviving children,and visual acuity was not affected in 3 cases.Conclusions:Pediatric orbital rhabdomyosarcoma that is limited can be treated better by surgery,chemotherapy and radioactive ^125I seeds implantation brachytherapy,but the unique complications of radioactive ^125I seeds need further study.