CAJ | 학술논문

目的探讨放射性125I粒子植入与药物对头颈部复发转移癌止痛效果的差异.方法 2011年1月至2012年10月收治的20例头颈部复发转移癌性疼痛患者,其中头颈部放疗后复发者9例,术后及放疗后复发者9例,术后复发者2例.随机分为粒子组10例,支持组10例.粒子组以CT病变作为参考靶区,应用近距离治疗计划系统(TPS)制定治疗计划,采用活度为1.31×107～2.96×107 Bq(0.3～0.8 mCi)的粒子,CT及B超双引导下植入,术后24 h内CT扫描,剂量验证D90为80 ～ 120 Gy.支持组遵循世界卫生组织三阶梯镇痛疗法给予药物支持治疗.随访观察两组的客观缓解率、疼痛缓解及并发症.结果随访6个月,粒子组术后1、2、3个月客观缓解率分别为50％、60％、80％,支持组治疗1、2、3个月客观缓解率均为0.两组疼痛评分中位值可控制在2～4分,支持组疼痛评分波动较粒子组大.粒子组未发现严重的放射性不良反应,支持组药物不良反应明显.结论放射性125I粒子植入治疗头颈部复发转移癌疼痛疗效确切,止痛起效快,并发症少.
목적 탐토방사성125I입자식입여약물대두경부복발전이암지통효과적차이.방법 2011년1월지2012년10월수치적20례두경부복발전이암성동통환자,기중두경부방료후복발자9례,술후급방료후복발자9례,술후복발자2례.수궤분위입자조10례,지지조10례.입자조이CT병변작위삼고파구,응용근거리치료계화계통(TPS)제정치료계화,채용활도위1.31×107～2.96×107 Bq(0.3～0.8 mCi)적입자,CT급B초쌍인도하식입,술후24 h내CT소묘,제량험증D90위80 ～ 120 Gy.지지조준순세계위생조직삼계제진통요법급여약물지지치료.수방관찰량조적객관완해솔、동통완해급병발증.결과 수방6개월,입자조술후1、2、3개월객관완해솔분별위50％、60％、80％,지지조치료1、2、3개월객관완해솔균위0.량조동통평분중위치가공제재2～4분,지지조동통평분파동교입자조대.입자조미발현엄중적방사성불량반응,지지조약물불량반응명현.결론 방사성125I입자식입치료두경부복발전이암동통료효학절,지통기효쾌,병발증소.
Objective To investigate the curative effectiveness of radioactive 125I-seed implantation and drug treatment in patients with pain caused by recurrent or metastatic head and neck cancers.Methods The retrospective analysis was done on 20 patients,concluding 9 recurrent cases after radiotherapy,9 cases after radiotherapy and operation,and 2 cases after operation,with pain caused by recurrent or metastatic head and neck cancers from Jan.2011 to Oct.2012.They were randomly divided into seed group and support group.The patients in seed group were implanted with 125I seeds guided by CT and ultrasound.The single seed activity ranged from 0.3-0.8 mCi (1.30 × 107-2.96 × 107 Bq).The implantation was carried out according to treatment planning system (TPS).The patients in support group were treated by drug for support treatment following three steps analgesic therapy from WHO.The pain remission rate,tumor control probability and complications were observed at regular intervals.Results The follow-up time was 6 months.The CR + PR in seed group was 50％,60％ and 80％ after 1,2 and 3 months respectively,and that in support group was 0 after 1,2 and 3 months.The median pain score of two groups was basically stable in 2-4,but the score in support group fluctuated more seriously than seed group.In addition,seed group had lighter complications.Conclusion For the treatment of pain caused by recurrent or metastatic head and neck cancers,interstitial implantation of 125I seeds has more reliable effect in relieving pain,less complication and faster onset of action.