放射性 125I 种子植入治疗无法手术或拒绝手术的头颈部癌症的疗效。
Efficacy of radioactive 125I seed implantation in treating inoperable or refused operation head and neck cancers.
机构信息
Department of Oncology, Hebei Medical University, Shijiazhuang, Hebei, China.
Department of Oncology, Hebei General Hospital, Shijiazhuang, Hebei, China.
出版信息
J Cancer Res Ther. 2024 Apr 1;20(2):642-650. doi: 10.4103/jcrt.jcrt_1891_23. Epub 2024 Apr 30.
PURPOSE
This study aims to observe the curative effect of radioactive 125I seed implantation in treating inoperable or refused operation head and neck cancer.
METHODS
Data from 132 patients with head and neck malignant tumors underwent computed tomography-guided radioactive 125I seed implantation from April 2004 to August 2020 were analyzed retrospectively. The Kaplan-Meier method was used to calculate the local control and survival rates. The logarithmic rank test and the Cox proportional risk model were used for univariate and multivariate analysis, respectively.
RESULTS
A total of 132 patients were enrolled. All tumors were confirmed to be malignant through pathological analysis. Herein, we revealed that the seeds were implanted at the primary tumor site (23 cases, representing 17.4%), recurrent (9 cases, representing 6.8%), or metastatic lymph nodes (100 cases, representing 75.8%). Three months after the operation, 96 patients were evaluated as effective, whereas 36 patients were considered ineffective. The median local control time was 16 months; the local rates at 6, 12, 18, and 24 months were observed to be 75%, 47%, 35%, and 22%, respectively. The study reports a median survival period (OS) of 15 months. Additionally, the survival rates at 6, 12, 18, and 24 months were 61%, 42%, 31%, and 27%, respectively. Regarding side effects, skin or mucosal toxicity occurred in 14 patients. Grade I skin toxicity occurred in seven cases (5.3%), grade IV skin toxicity in one case (0.8%), grade I mucosal ulcer in four cases (3.0%), and grade I dry mouth in four cases (3.0%). The multivariate analysis showed that short-term efficacy and tumor site were independent prognostic factors (P < 0.001, 0.006, respectively). Additionally, the multivariate analysis showed that the independent OS influencing factors included D90, the longest tumor diameter, and short-term efficacy (P = 0.017, 0.001, <0.001).
CONCLUSION
Radioactive 125I seed implantation is a safe and effective salvage therapy for patients with inoperable or refused operation head and neck cancer.
目的
本研究旨在观察放射性 125I 种子植入治疗无法手术或拒绝手术的头颈部癌症的疗效。
方法
回顾性分析 2004 年 4 月至 2020 年 8 月接受 CT 引导放射性 125I 种子植入的 132 例头颈部恶性肿瘤患者的数据。采用 Kaplan-Meier 法计算局部控制率和生存率。对数秩检验和 Cox 比例风险模型分别用于单因素和多因素分析。
结果
共纳入 132 例患者。所有肿瘤均经病理分析证实为恶性。在此，我们发现种子植入于原发肿瘤部位（23 例，占 17.4%）、复发（9 例，占 6.8%）或转移性淋巴结（100 例，占 75.8%）。术后 3 个月，96 例患者评估为有效，36 例患者评估为无效。中位局部控制时间为 16 个月；6、12、18 和 24 个月的局部控制率分别为 75%、47%、35%和 22%。本研究报告中位总生存期（OS）为 15 个月。此外，6、12、18 和 24 个月的生存率分别为 61%、42%、31%和 27%。关于副作用，14 例患者出现皮肤或黏膜毒性。7 例（5.3%）为 1 级皮肤毒性，1 例（0.8%）为 4 级皮肤毒性，4 例（3.0%）为 1 级黏膜溃疡，4 例（3.0%）为 1 级口干。多因素分析显示，近期疗效和肿瘤部位是独立的预后因素（P<0.001，0.006）。此外，多因素分析显示，独立影响 OS 的因素包括 D90、最长肿瘤直径和近期疗效（P=0.017，0.001，<0.001）。
结论
放射性 125I 种子植入是治疗无法手术或拒绝手术的头颈部癌症患者的一种安全有效的挽救性治疗方法。
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