中华放射医学与防护杂志

朱俏,张建国,郑磊.放射性粒子治疗早期腮腺癌靶区优化初步研究[J].中华放射医学与防护杂志,2018,38(3):197-200

放射性粒子治疗早期腮腺癌靶区优化初步研究

Primary result of early parotid gland carcinomas with optimized target design brachytherapy

投稿时间：2017-08-16

DOI：10.3760/cma.j.issn.0254-5098.2018.03.007

英文关键词:Early parotid gland ¹²⁵I seed Optimized target design

基金项目:

作者	单位	E-mail
朱俏	100101 北京大学口腔医学院口腔医院口腔疾病临床研究中心口腔数字化医疗技术和材料国家工程实验室口腔数字医学北京市重点实验室, 第二门诊部
张建国	100101 北京大学口腔医学院口腔医院口腔疾病临床研究中心口腔数字化医疗技术和材料国家工程实验室口腔数字医学北京市重点实验室, 口腔颌面外科	rszhang@126.com
郑磊	100101 北京大学口腔医学院口腔医院口腔疾病临床研究中心口腔数字化医疗技术和材料国家工程实验室口腔数字医学北京市重点实验室, 口腔颌面外科

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中文摘要:

目的分析采用部分腮腺靶区行放射性粒子治疗早期腮腺癌的可行性。方法回顾2004年11月至2013年2月在本院就诊的早期腮腺癌患者14例，所有患者手术均行肿物局部切除，术后联合¹²⁵I放射性粒子植入，根据靶区设计不同分为两组，部分腮腺靶区组和全腮腺靶区组，每组7例。比较两组患者的总生存率及局部控制率，并比较两组病例靶区体积、植入粒子数量、患侧下颌骨升支、咽缩肌、颈髓、外耳道、中耳、乳突等危及器官的受照剂量。结果经随访51~116个月，两组病例均未见局部区域复发及远处转移，总生存率及局部控制率均为100%。部分腮腺靶区组CTV D₉₀平均为（90.3±20.4）Gy，全腮腺靶区组CTV D₉₀平均为（104.3±10.1）Gy，两组之间差异无统计学意义（P>0.05）。部分腮腺靶区组和全腮腺靶区组的靶区体积平均分别为（9.2±2.4）和（35.1±13.5）cm³（t=5.003，P<0.05）。两组患侧下颌骨升支、咽缩肌、外耳道、中耳、乳突平均剂量及颈髓最大剂量相比较，差异均有统计学意义（t=3.534、4.279、3.034、3.471、7.221、6.103，P<0.05），部分腮腺靶区组较全腮腺靶区组靶区体积缩小、危及器官受照剂量明显降低。结论早期低度恶性腮腺癌保守切除后，近距离治疗采用肿瘤周围区域的部分腮腺靶区具有一定的可行性，在保证临床疗效的同时可降低对正常组织的损伤。

英文摘要:

Objective To analyze the feasibility of local target in early parotid carcinoma brachytherapy. Methods The retrospective study collected 14 early parotid gland carcinoma patients during November 2004 and February 2013 at Peking University School and Hospital of Stomatology. All of them proceeded conservative surgery and ¹²⁵I interstitial brachytherapy postoperatively. According to the different target designs, the patients were divided into two groups as local target group and whole target group. The disease-free survival rate and overall survival rate were analyzed. The target volume, the number of ¹²⁵I seeds and dose of crisis organs such as mandibular ramus, pharynx constrictor, cervical spinal cord, external auditory canal, middle ear, mastoid in the affected side were compared between two groups. Results After 51-116 months of follow-up, disease-free survival rate and overall survival rate in both groups were 100%. The mean D₉₀ of CTV in local target group was(90.3±20.4)Gy, and (104.3±10.1)Gy in whole target group. There was no statistical difference between two groups(P>0.05), while there were statistical differences in target volume(t=5.003,P<0.05), which were (9.2±2.4) and(35.1±13.5)cm³ respectively. Mean dose of organs at risk between two groups including mandibular ramus, pharynx constrictor, external auditory canal, middle ear, mastoid and maximal dose of cervical spinal cord in the affected side also had significant differences(t=3.534,4.279,3.034,3.471,7.221,6.103,P<0.05). Local target group had less target volume and less dose in organs at risk. Conclusions The conservative surgery combined with local target brachytherapy is feasible for the early low grade parotid gland carcinomas, with acceptable survival rate and less risk in organs at risk.

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