组织间^(125)I放射粒子植入治疗头颈部恶性肿瘤颈部淋巴结转移的临床应用  

Clinical application of interstitial implantation of 125I radion in the treatment of cervical lymph node metastasis of head and neck malignancy

作　　者：李福生[1] 黄海[1] 徐绍年[1] 杜振广[1] 王亮[1] 

机构地区：[1]辽宁省人民医院骨肿瘤科,110016

出　　处：《中国实用医药》2014年第28期18-20,共3页China Practical Medicine

摘　　要：目的探讨组织间125I放射粒子植入治疗头颈部恶性肿瘤颈部淋巴结转移的价值。方法对21例头颈部恶性肿瘤颈部淋巴结转移患者进行125I放射粒子植入治疗,术前行TPS(computer-based treatment planning system)计划、根据计划在CT引导局部麻醉下行颈部淋巴结转移瘤125I放射粒子植入、术后复查CT进行质量验证。根据NRS评分对术前术后患者局部疼痛进行评估,按WHO标准对局部肿瘤控制疗效进行评价。结果随访7~29个月,21例患者均成功行手术治疗,术后3个月复查,完全缓解3例(14%)、部分缓解15例(71%)、病变稳定2例(10%)、病变进展1例(5%);6个月、1、2年的局部控制率(局部肿瘤无进展)分别为:84%、65%、39%;NRS疼痛评分术前、术后3个月、6个月分别为:(7.62±0.92)分,(2.81±0.68)分,(2.14±0.39)分(P<0.05)。3例患者术后出现发热,未超过38.5℃,3~5 d内恢复正常;3例皮肤黏膜1级急性放射性损伤,2例皮肤黏膜2级急性放射性损伤,无3~5级皮肤黏膜急性放射性损伤。所有患者未发生大出血、急性肺栓塞、窦道等严重并发症。结论组织间125I放射粒子植入治疗头颈部恶性肿瘤颈部淋巴结转移创伤小,并发症少,局部控制率较高,疼痛缓解明显,为不能手术的晚期头颈部恶性肿瘤颈部淋巴结转移的患者提供了一种新型治疗手段。Objective To explore the value of interstitial implantation of 125I radion in the treatment of cervical lymph node metastasis of head and neck malignancy. Methods There were 21 patients with cervical lymph node metastasis of head and neck malignancy received 125I radion implantation. Computer-based treatment planning system（TPS） was operated before the surgery, and implantation of 125I radion was conducted under CT guidance and local anesthesia. Postoperative CT review was used for quality verification. Numerical rating scale（NRS） was used to assess patients’ local pain before and after surgery, and WHO standard was applied to evaluate the curative effect of local tumor control. Results The follow-up period ranged from 7 months to 29 months. All patients underwent operation, and recovered after 3 months. There were 3 complete remission cases（14%）, 15 partial remission cases（71%）, 2 stable disease cases（10%）, and 1 progression disease case（5%）. The Local control rates of 6 months, 1 year, and 2 years were 84%, 65%, and 39 %. NRS scores of preoperation, 3 months after operation, and 6 months after operation were（7.62±0.92） points,（2.81±0.68） points,（2.14±0.39） points（P〈0.05）. 3 cases had postoperative fever below 38.5℃, and recovered in 3 to 5 d. 3 cases had level 1 acute radiation injury of skin mucous membrane, and 2 cases had level 2 acute radiation injury of skin mucous membrane. There was no level 3 to 5 acute radiation injury of skin mucous membrane. All patients did not appear severe complications, such as hemorrhoea, pulmonary embolism, and sinus tract. Conclusion Interstitial implantation of 125I radion is a minimal invasive procedure with small wound, minor complications, high local control, and obvious pain relief. It is a feasible and safe treatment for cervical lymph node metastasis of head and neck malignancy at inoperable late period.

关 键 词：头颈部恶性肿瘤 颈部淋巴结转移 125I放射粒子 永久植入 

分 类 号：R739.91[医药卫生—肿瘤]