放射性粒子组织间植入近距离放疗在颅底腺源性恶性肿瘤治疗中的应用  

Application of radioactive particle interstitial implant brachytherapy in the treatment of malignant adenogenous tumors invaded into cranial base area

作　　者：许宁 郑磊[1] 张杰[1] 黄明伟[1] 刘树铭[1] 吕晓鸣 石妍[1] 张建国[1] 

机构地区：[1]北京大学口腔医学院口腔颌面外科,100081

出　　处：《实用口腔医学杂志》2017年第6期798-801,共4页Journal of Practical Stomatology

摘　　要：目的:评价应用^(125)I放射性粒子组织间植入治疗侵犯颅底区的腺源性恶性肿瘤的初步疗效,并行预后相关因素分析。方法:纳入患者24例,肿瘤病理学类型包括腺样囊性癌、腺泡细胞癌、多形性腺瘤恶变、黏液表皮样癌、腺癌、肌上皮癌。侵犯部位包括前颅底、中颅底、侧颅底3个区域中的1个或多个,采用^(125)I放射性粒子,以1~1.5 cm间距、CT、个体化导板以及术中导航系统或联合引导布放粒子,处方剂量60~160 Gy。治疗后定期复查随访,观察疗效及并发症,统计生存率、局部复发率及远处转移率,评价治疗的安全性,并分析年龄、病理学类型、侵犯部位、肿瘤最大径及有无放疗史是否为预后相关因素。结果:随访时间3~72个月,中位随访时间为27个月,无失访,总生存率41.7%,局部复发率25.0%,远处转移率37.5%,1、3、5年累积生存率分别为79%、67%、24%;出现4级放疗反应者2例;有局部复发者生存率低于无复发者(P=0.047),有、无远处转移者生存率无明显差异(P=0.649),肿瘤最大径为预后相关因素(OR=0.106)。结论:^(125)I放射性粒子肿瘤组织间植入治疗颅底腺源性恶性肿瘤微创、安全有效,预后与局部复发及肿瘤最大径有关。Objective： To study the effects of brachytherapy with l^I in the treatment of malignant adenogenous tumors invaded into cranial base area, and to evaluate the correlative factors of prognosis. Methods： 24 patients with malignant adenogenous tumors invaded into cranial base area were treated by 1~ I seeds implanted into the tumors with the spacing of 1 - 1.5 cm and guided by CT, individual guide plate and navigation system respectively or in combination with the dose of 60 - 160 Gy. Survival rate, local recurrence rate, distant metastasis and safty of the treatment were evaluated. The correlative factors of prognosis included age, pathology diagnosis, diameter of the tumor, area of tumor invasion and history of radiotherapy were analyzed. Results： The follow-up time of the patients was 3 - 76 months and the median was 27 months. 2 patients came up with radiotherapy reaction of level 4. The total survival rate was 41.7%, the local recurrence rate was 25.0% and the distant metastasis rate was 37.5%. The cumulative survival rate of 1,3 and 5 years was 79%, 67% and 24% respectively. Significant correlation was found between prognosis and local recurrence as well as the diameter of the tumor. Conclusion： 125I brachytherapy provides a safe and feasible technique with minimal damage for treating malignant adenogenous tumors invaded into cranial base area. The prognosis is related to local recurrence and the diameter of the tumor.

关 键 词：125I放射性粒子 近距离放疗 颅底区 腺源性恶性肿瘤 

分 类 号：R739.8[医药卫生—肿瘤]