放射性125I粒子治疗头颈部复发恶性肿瘤35例近期疗效观察

摘要

[目的]探讨利用B超或CT引导下放射性125I粒子组织间植入内照射治疗术后不能耐受放化疗或放化疗失效后复发的头颈部恶性肿瘤临床价值.[方法]2008年7月至2010年5月共收治35例头颈部恶性肿瘤综合治疗后复发患者,其中男21例,女14例,中位年龄49(22～76)岁,局部麻醉,间距1 cm,以术前治疗计划系统(TPS)计划的粒子数及进针方向做参考,注意避开重要血管及神经,在B超或CT定位下用粒子针进行植入,粒子针插植边缘达到肿瘤影像学边缘,粒子间距0.5～1 cm,术后即行超声复查,了解粒子分布状况,必要时进行补植入,避免剂量冷区.粒子活度为1.85×107Bq～2.96×107Bq,中位植入粒子数27(3～58)粒.[结果]根据疗效评估标准,1～6个月后进行CT扫描,其中CR 25.7%(9/35),PR 51.4%(18/35),NC 14.3%(5/35),PD 8.6%(3/35),总有效率CR+PR 77.1%(27/35).随访6～28个月,6个月局部控制率91.4%,1年57.8%,2年40.1%.6个月,1年,2年总生存率分别为100%,55.2%,30.2%.[结论]在B超和CT引导下植入125I粒子进行肿瘤体内照射,植入精确可控,微创,安全,近期疗效确切,是治疗头颈部复发恶性肿瘤的新方法.%[Objective] To explore the clinical value of internal radiation with radioactive 125I seed interstitial implantation under ultrasound or CT guidance for the treatment of recurrent head and neck malignant tumor unable to tolerate radiochemotherapy or failed to radiochemotherapy after operation. [Methods] Thirty five patients with recurrent head and neck malignant tumor(21 males and 14 females, an average age of 49 years old ranged from 22 to 76years old) from July 2008 to May 2010 were enrolled in this study. The number of seeds and the direction of needle insertion by preoperative treatment planning system(TPS) were taken as the reference. The important vessels and nerves should be avoided. Under local anesthesia, seed needle with the internal of 0.5～lcm under B-ultrasound or CT guidance was inserted in the edge of tumor imaging. After operation, ultrasound reexamination was performed immediately to understand the seed distribution. If necessary, the seed was additionally implanted avoiding the cold area of the dose. The seed activity was 1. 85 × 107 Bq～2.96 × 107 Bq, and the number of mean implanted gseed was 27(3～58). [Results] According to curative effect assessment standard, CT scanning 1～6 months later showed that CR was 25.7％ (9/35), and PR was 51.4％ (18/35), and NC was 14.3％ (5/35), and PD was 8. 6％ (3/35). The total effective rate(CR+ PR) was 77.1 ％ (27/35). All patients were followed up for 6 ～ 28 months. The local control rate of 6 months was 91.4％, and that of 1 year was 57. 8％, and that of 2 years was 40.1％. The overall survival rate of 6 months, 1 year and 2 years was 100％, 55.2％ and 30.2％, respectively. [Conclusion] Internal radiation with radioactive 125 I seed interstitial implantation under ultrasound or CT guidance is precise, controllable, minimally invasive and safe, and the short-term efficacy was certain. Therefore it is a new treatment method of recurrent head and neck malignant tumor.