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目的探讨超声引导下放射性125I粒子组织间植入治疗头颈部肿瘤的技术可行性和近期疗效。方法选择30例头颈部癌术后或放疗后复发或转移患者。局部浸润麻醉,超声引导下125I粒子植入术。粒子针平行排列,间距1~1.5cm,原发肿瘤边缘外放1cm,转移瘤为影像学边界。利用Mick枪后退式植入粒子,粒子间距1cm。肿瘤周边匹配剂量(matched peripheral dose,MPD)90~160Gy,每颗粒子活度0.40~0.70mCi,每个病灶植入3~84颗粒子,中位粒子数24颗。10例粒子剂量低于130Gy者,术后1周加外放疗,每次2Gy,总剂量45~50Gy。术后24h拍头颈正侧位和胸部X线片,了解粒子移位或游走。结果随访3~33个月,中位数12个月。全组局部控制率为93.3%(28/30),2例因局部复发死亡。1年和2年生存率分别为51.7%和19.4%,中位生存期12个月。无严重皮肤反应。结论放射性125I粒子植入治疗头颈部癌疗效确切,尤其是对那些手术后或放疗复发患者提供了一种安全和微创的治疗手段。
Objective To investigate the technical feasibility and short-term curative effect of ultrasound-guided 125I seed implantation in the treatment of head and neck cancer. Methods Thirty patients with recurrent or metastatic head and neck cancer were selected after surgery or after radiotherapy. Local anesthesia, ultrasound-guided 125I particle implantation. Particle needle parallel arrangement, spacing 1 ~ 1.5cm, the edge of the primary tumor 1cm, the tumor as the imaging boundary. Retrograde use of Mick gun implanted particles, particle spacing 1cm. The matched peripheral dose (MPD) of 90 ~ 160Gy and activity per particle ranged from 0.40 to 0.70mCi, with 3 ~ 84 particles and 24 median particles per lesion. 10 cases of particle dose less than 130Gy, 1 week after surgery plus external radiotherapy, each 2Gy, the total dose of 45 ~ 50Gy. 24h postoperative head and neck and chest X-ray film, to understand the particle shift or walk. The results were followed up for 3 to 33 months, with a median of 12 months. The whole group of local control rate was 93.3% (28/30), 2 patients died of local recurrence. The 1-year and 2-year survival rates were 51.7% and 19.4%, respectively, with a median survival of 12 months. No serious skin reaction. Conclusion The radioactive 125I seed implantation for the treatment of head and neck cancer has definite curative effect, especially for patients who have surgery or radiotherapy and relapse and provide a safe and minimally invasive treatment.