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

发布时间：2019-03-12 21:11

【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。
[Abstract]:Aim: to evaluate the preliminary efficacy of 125i radioactive particle implantation in the treatment of adenogenic malignant tumors invading the skull base, and to analyze the prognostic factors. Methods: 24 patients were included in this study. The pathological types included adenoid cystic carcinoma, acinar cell carcinoma, malignant transformation of pleomorphic adenoma, mucoepidermoid carcinoma, adenocarcinoma and myoepithelial carcinoma. The site of invasion included one or more of the three regions of the anterior skull base, the middle skull base, and the lateral skull base. ~ (125) I radioactive particles were used, the CT, individualized guide plate and the intraoperative navigation system or the combined guidance were used to distribute the particles at a distance of 1? 1.5? Prescription dose 60: 160 Gy. Follow-up was carried out regularly after treatment to observe the curative effect and complications, statistical survival rate, local recurrence rate and distant metastasis rate, evaluate the safety of treatment, and analyze age, pathological type and site of invasion. The maximum diameter of tumor and the history of radiotherapy were prognostic factors. Results: the median follow-up time was 27 months. The overall survival rate was 41.7%, local recurrence rate was 25.0%, distant metastasis rate was 37.5%, 1,3,5-year cumulative survival rate was 79%, 67%, 24%, respectively. The survival rate of patients with local recurrence was lower than that of patients without recurrence (P < 0. 047). There was no significant difference in survival rate of patients with no distant metastasis (P = 0. 649). The maximum diameter of tumor was associated with prognosis (OR=0.106). Conclusion: ~ (125) I radioactive particle tumor tissue implantation is safe and effective in the treatment of adenogenic malignant tumor of skull base. The prognosis is related to local recurrence and maximum diameter of tumor.
【作者单位】：北京大学口腔医学院口腔颌面外科;
【分类号】：R739.8

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