^(125)I粒子近距离治疗在局部晚期腮腺腺样囊性癌的应用

Application of ^(125)I interstitial brachytherapy in the treatment of local advanced parotid adenoid cystic carcinoma

目的单纯应用^(125)I放射性粒子组织间植入治疗局部晚期腮腺腺样囊性癌,评估疗效并分析相关预后因素,为局部晚期腮腺腺样囊性癌的治疗提供临床参考。方法回顾性纳入2007年8月至2018年1月于北京大学口腔医院接受单纯应用^(125)I放射性粒子植入治疗的局部晚期腮腺腺样囊性癌患者,分析其总生存率(OS)、无进展生存率(PFS)和局部控制率(LCR)及相关影响因素,并观察近、远期放射不良反应情况。结果本组病例共16例(cT4bN0M0),女性患者占多数(11/16,68.7%),中位年龄55.4岁。随访8~104个月(中位时间41.5个月),1、3、5年LCR分别为93.7%、80%、68.7%,1、3、5年OS分别为86.7%、72%、54%;1、3、5年PFS分别为74%、53%、18.9%。9例(56.2%)患者出现不同部位器官转移,以颅内转移、肺转移常见;其中6例术前伴有颅底骨质侵犯者出现多器官转移,肿瘤侵犯颈动脉是影响远处转移的危险因素(HR=12,P=0.045)。共有8例(8/16,50%)患者出现不同程度远期放射性不良反应。结论单纯应用^(125)I放射性粒子植入治疗局部晚期腮腺腺样囊性癌的5年局部控制率为68.7%,肿瘤侵犯颅底骨质、包绕颈动脉是其预后不佳与发生多器官远处转移的主要因素。

Objective To evaluate the efficacy of ^(125)I interstitial brachytherapy in the treatment of local advanced parotid adenoid cystic carcinoma(ACC),and to analyze prognostic factors affecting treatment outcome,in order to provide references for the treatment of local advanced parotid adenoid cystic carcinoma.Methods Patients with histology-confirmed ACC of the parotid who received ^(125)I interstitial brachytherapy in Peking University Hospital of Stomatology between Aug 2007 and Jan 2018 were included.Prognostic factors affecting overall survival(OS),progression-free survival(PFS),and local control rate(LCR)were analyzed.Meanwhile,distant metastases as well as acute and long-term radiological toxicities were described.Results A total of 16 patients(11 females,mean age 55.4 years)of stage cT4bN0M0 who received definitive ^(125)I interstitial brachytherapy were included.The median follow-up period was 41.5 months(8-104 months),and the 1-,3-and 5-year OS were 86.7%,72%and 54%,respectively.Five patients suffered from local recurrence,the 1-,3-and 5-year LCR were 93.7%,80%and 68.7%,respectively,and the 1-,3-and 5-year PFS were 74%,53%,and 18.9%,respectively.Nine cases developed distant metastases.Among them,intracranial and pulmonary metastases took place the most frequently and six patients who had skull base invasion developed multi-organ metastases.An encased carotid artery was an independent prognostic factor for distant metastases(HR=12,P=0.045).Severe radiological toxicities were observed in eight patients(8/16,50%),including radio-dermatitis,hearing loss,progressive trismus,and eye toxicities.Conclusions The 5-year LCR in patients treated with definitive ^(125)I interstitial brachytherapy for local advanced ACC of the parotid was 68.7%,and skull base invasion and an encased carotid artery were independent adverse prognostic factors of bad prognosis and multi-organ metastases.