Jiang Y L, Ji Z, Tian S Q, Guo F X, Yuan H S, Liu C, Sun H T, Wang J J
Department of Radiation Oncology, Peking University Third Hospital, Beijing 100191, China.
Zhonghua Yi Xue Za Zhi. 2018 Dec 4;98(45):3686-3691. doi: 10.3760/cma.j.issn.0376-2491.2018.45.011.
To investigate the efficacy of CT-guidance interstitial Iodine-125 seed brachytherapy as a salvage therapy for recurrent head and neck carcinoma. A total of 122 patients who had been treated for recurrent head and neck carcinoma with CT-guided Iodine-125 seed permanent implantation were conducted a retrospective analysis at Peking University Third Hospital from February 2003 to December 2015. The study included 78 male and 44 female patients. Of the 122 patients, 76 had undergone radical surgery, 106 had received EBRT. Among the patients who underwent EBRT, the total dose delivered to PTV ranged from 30 to 140 Gy (median, 68.4 Gy). The actuarial median number of the implanted Iodine-125 seeds was 38 (range, 5-158). The specific activity of Iodine-125 seeds ranged from 14.8 to 28.9 MBq/seed (median, 22.2 MBq). The evaluation of post plan showed the actuarial D90 ranged from 46 to 282 Gy (median, 121 Gy). The overall local control and survival times were determined by using the - method from SPSS 13.0.Univariate analysis was performed on the local control rate and overall survival rate. Tumor responses rate was 75.4%. The median local control time was 10.0 months (95% 9.8-24.2 months), and the 1-, 2-, 3-, and 5-year local control were 41.9%, 21.2%, 3.7%, and 3.7%, respectively. Univariate analysis showed that the local control in D90≥120 Gy group had an increasing tendency, but no statistical difference were found. The effect of local control in the squamous cell carcinoma group was slightly worse than that in the non-squamous cell carcinoma group (=0.032). Multi-factor analysis showed that the effect of local control in the squamous cell carcinoma group was slightly poor (=0.03). The median survival time was 14 months (95% 14.4-35.8 months), and the 1-, 2-, 3- and 5-year survival rate were 51.5%, 34.2%, 19.4%, and 19.4%, respectively. The three factors, such as the tumor responses, KPS status before the seed implantation, and the D90 after the seed implantation, had a tendency to improve the total survival, but there was still no statistical differences. Multivariate analysis showed no clear influence factors. Interstitial permanent Iodine-125 seed implantation is an effective salvage re-irradiation modality for recurrent head and neck carcinoma after previous surgery and/or EBRT. CT image-guided method could yield the reliable seeds configuration and accurate dose distribution.
探讨CT引导下组织间碘-125粒子植入近距离治疗作为复发性头颈癌挽救性治疗的疗效。对2003年2月至2015年12月在北京大学第三医院接受CT引导下碘-125粒子永久植入治疗复发性头颈癌的122例患者进行回顾性分析。研究包括78例男性和44例女性患者。122例患者中，76例行根治性手术，106例接受过体外放射治疗（EBRT）。在接受EBRT的患者中，计划靶体积（PTV）的总剂量为30至140 Gy（中位数为68.4 Gy）。植入碘-125粒子的精算中位数为38枚（范围为5至158枚）。碘-125粒子的比活度为14.8至28.9 MBq/粒（中位数为22.2 MBq）。计划后评估显示精算D90为46至282 Gy（中位数为121 Gy）。采用SPSS 13.0软件的-方法确定总体局部控制率和生存时间。对局部控制率和总生存率进行单因素分析。肿瘤缓解率为75.4%。局部控制的中位数时间为10.0个月（95% 9.8至24.2个月），1年、2年、3年和5年的局部控制率分别为41.9%、21.2%、3.7%和3.7%。单因素分析显示，D90≥120 Gy组的局部控制有增加趋势，但差异无统计学意义。鳞状细胞癌组的局部控制效果略低于非鳞状细胞癌组（P=0.032）。多因素分析显示，鳞状细胞癌组的局部控制效果略差（P=0.03）。中位生存时间为14个月（95% 14.4至35.8个月），1年、2年、3年和5年生存率分别为51.5%、34.2%、19.4%和19.4%。肿瘤缓解、粒子植入前的KPS状态和粒子植入后的D90这三个因素有改善总生存的趋势，但仍无统计学差异。多因素分析未显示明确的影响因素。组织间永久碘-125粒子植入是既往手术和/或EBRT后复发性头颈癌有效的挽救性再照射方式。CT图像引导方法可获得可靠的粒子构型和准确的剂量分布。
