CAJ | 학술논문

目的：初步探讨125I粒子植入治疗外放后复发的颈部淋巴结转移癌的安全性及疗效。方法对2011年8月-2012年7月收治的17例颈部淋巴结转移癌既往接受外放疗再次复发患者行回顾性研究。17例患者23处病灶，应用近距离治疗计划系统（TPS）制订治疗计划，确定粒子数目、活度及分布，粒子活度0.3~0.8 mCi，肿瘤处方剂量为60~120 Gy，CT及B超双引导下植入，术后24 h内CT扫描，剂量验证D90为（81.4±2.1）Gy。术后每2个月复查CT检测肿瘤大小变化并观察并发症。结果随访6个月，局部控制率为65.2%，其中，小于4 cm 的淋巴结控制率（CR + PR）为90%，而大于4 cm 的为46%， P =0.038，差异有统计学意义；颈Ⅰ、Ⅱ、Ⅲ、Ⅴ区淋巴结各控制率（CR+PR）与未控制率（SD+PD）比较，差异无统计学意义（P>0.05）；孤立而边界清楚的21个淋巴结控制率为71%，融合而边界不清的淋巴结局部控制率为0。急性皮肤放疗反应Ⅱ度8例，Ⅰ度7例，无严重的其他放疗并发症。结论125Ⅰ粒子植入治疗外放疗后复发的颈部淋巴结转移癌近期疗效好、创伤小、并发症少。小于4 cm且孤立、边界清楚的淋巴结更适合粒子植入治疗。
목적：초보탐토125I입자식입치료외방후복발적경부림파결전이암적안전성급료효。방법대2011년8월-2012년7월수치적17례경부림파결전이암기왕접수외방료재차복발환자행회고성연구。17례환자23처병조，응용근거리치료계화계통（TPS）제정치료계화，학정입자수목、활도급분포，입자활도0.3~0.8 mCi，종류처방제량위60~120 Gy，CT급B초쌍인도하식입，술후24 h내CT소묘，제량험증D90위（81.4±2.1）Gy。술후매2개월복사CT검측종류대소변화병관찰병발증。결과수방6개월，국부공제솔위65.2%，기중，소우4 cm 적림파결공제솔（CR + PR）위90%，이대우4 cm 적위46%， P =0.038，차이유통계학의의；경Ⅰ、Ⅱ、Ⅲ、Ⅴ구림파결각공제솔（CR+PR）여미공제솔（SD+PD）비교，차이무통계학의의（P>0.05）；고립이변계청초적21개림파결공제솔위71%，융합이변계불청적림파결국부공제솔위0。급성피부방료반응Ⅱ도8례，Ⅰ도7례，무엄중적기타방료병발증。결론125Ⅰ입자식입치료외방료후복발적경부림파결전이암근기료효호、창상소、병발증소。소우4 cm차고립、변계청초적림파결경괄합입자식입치료。
Objective To investigate the safety and effectiveness of radioactive 125I seed implantation in treating recurrent cervical lymphatic metastases after radiotherapy. Methods During the period from Aug. 2011 to July 2012, 17 patients with recurrent cervical lymphatic metastases who had received radiotherapy before were admitted to authors’ hospital. The clinical data were retrospectively analyzed. A total of 23 metastatic lymph nodes were detected in the 17 patients. Brachytherapy treatment planning system (TPS) was used to formulate the number, activity and distribution of radioactive 125I seeds. The radioactive activity was 0.3 - 0.8 mCi (1.30 × 107- 2.96 × 107 Bq), and the matched peripheral dose (MPD) was 60 - 120 Gy. Guided by ultrasound and CT radioactive 125I seeds were implanted under local anesthesia. CT scanning was performed within 24 hours after the procedure. Postoperative D90 was (81.4 ± 2.1) Gy. CT examination was employed every two months to determine the tumor size and to record the complications. Results All patients were followed up for 6 months. The 6-month local control rate was 65.2%. The control rates (CR+PR) for<4 cm (n=10) and>4 cm (n=13) lymph nodes were 90%and 46%respectively, the difference between the two was statistically significant (P = 0.038). No significant difference existed between the control rate (CR + PR) and the un-control rate (SD + PD) for each lymph node group at cervical Ⅰ, Ⅱ, Ⅲ and Ⅴ grade Ⅱ was seen in 8 cases and grade Ⅰ in 7 cases. No severe complications occurred. Conclusion For the treatment of recurrent cervical lymphatic metastases after radiotherapy, radioactive 125I seed implantation is effective and mini-invasive with fewer complications. This technique is more suitable for < 4 cm solitary metastatic lymph node with clear border.