Horiuchi J, Takeda M, Shibuya H, Matsumoto S, Hoshina M, Suzuki S
Department of Radiology, School of Medicine, Tokyo Medical and Dental University, Japan.
Radiother Oncol. 1991 May;21(1):29-38. doi: 10.1016/0167-8140(91)90338-h.
A series of 177 patients with squamous cell carcinoma of the oral cavity and oropharynx were treated with 198Au grain (gold grain) implants. Sites of the lesion included the tongue, mouth floor, buccal mucosa and oropharynx, especially the soft palate and faucial arch. Three-fourths of the patients were treated in combination with prior external beam irradiation. A permanent implant dose (total decay) of 80-90 Gy was given in the form of gold grains alone and in combination with an external dose of no more than 30 Gy, and 60-70 Gy, total decay, was given after an external dose greater than 30 Gy. The 2-year recurrence-free rate was 86.2% in the case of T1N0, 72.6% in T2N0 and 72.2% in T3N0. The difference in the results of implant therapy alone and combined therapy was not significant. Late complications were minimal after grain implantation alone, and when used in combination, less than 70 mCi of grain activity after a 40 Gy external dose did not seem to be a serious hazard with respect to bone damage except in the case of cancer of the mouth floor. Gold grain implants were useful and easily applied under local anesthesia to early or superficial lesions at sites where a rigid linear source could not be used. Exposure of the radiology staff was only 5-10 mrad in the case of the usual 10-15 (50-75 mCi) implant grains.
177例口腔和口咽鳞状细胞癌患者接受了¹⁹⁸Au粒子（金粒子）植入治疗。病变部位包括舌、口底、颊黏膜和口咽，尤其是软腭和咽弓。四分之三的患者在植入前接受了外照射联合治疗。单独使用金粒子时，永久植入剂量（总衰变）为80 - 90 Gy，联合不超过30 Gy的外照射剂量；外照射剂量大于30 Gy后，总衰变剂量为60 - 70 Gy。T1N0患者的2年无复发生存率为86.2%，T2N0为72.6%，T3N0为72.2%。单纯植入治疗和联合治疗结果的差异不显著。单纯粒子植入后的晚期并发症极少，联合治疗时，外照射剂量40 Gy后粒子活度小于70 mCi，除口底癌外，对骨损伤似乎并非严重危害。金粒子植入对于早期或浅表病变且无法使用刚性直线源的部位很有用，并且在局部麻醉下易于应用。对于通常10 - 15个（50 - 75 mCi）植入粒子的情况，放射科工作人员的照射剂量仅为5 - 10 mrad。
