中华放射医学与防护杂志

高雅,张杰,刘树铭,等.¹²⁵I粒子近距离治疗在局部晚期腮腺腺样囊性癌的应用[J].中华放射医学与防护杂志,2021,41(1):9-13.Gao Ya,Zhang Jie,Liu Shuming,et al.Application of ¹²⁵I interstitial brachytherapy in the treatment of local advanced parotid adenoid cystic carcinoma[J].Chin J Radiol Med Prot,2021,41(1):9-13

¹²⁵I粒子近距离治疗在局部晚期腮腺腺样囊性癌的应用

Application of ¹²⁵I interstitial brachytherapy in the treatment of local advanced parotid adenoid cystic carcinoma

投稿时间：2020-05-25 修订日期：2020-05-25

DOI：10.3760/cma.j.issn.0254-5098.2021.01.003

中文关键词: 腮腺腺样囊性癌 ¹²⁵I放射性粒子近距离治疗局部晚期

英文关键词:Parotid Adenoid cystic carcinoma ¹²⁵I radioactive seeds Interstitial brachytherapy Local advanced stage

基金项目:

作者	单位	E-mail
高雅	北京大学口腔医学院· 口腔医院口腔颌面外科国家口腔疾病临床医学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 100081
张杰	北京大学口腔医学院· 口腔医院口腔颌面外科国家口腔疾病临床医学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 100081
刘树铭	北京大学口腔医学院· 口腔医院口腔颌面外科国家口腔疾病临床医学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 100081
郑磊	北京大学口腔医学院· 口腔医院口腔颌面外科国家口腔疾病临床医学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 100081
黄明伟	北京大学口腔医学院· 口腔医院口腔颌面外科国家口腔疾病临床医学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 100081
张建国	北京大学口腔医学院· 口腔医院口腔颌面外科国家口腔疾病临床医学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 100081	rszhang@126.com

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中文摘要:

目的单纯应用¹²⁵I放射性粒子组织间植入治疗局部晚期腮腺腺样囊性癌，评估疗效并分析相关预后因素，为局部晚期腮腺腺样囊性癌的治疗提供临床参考。方法回顾性纳入2007年8月至2018年1月于北京大学口腔医院接受单纯应用¹²⁵I放射性粒子植入治疗的局部晚期腮腺腺样囊性癌患者，分析其总生存率（OS）、无进展生存率（PFS）和局部控制率（LCR）及相关影响因素，并观察近、远期放射不良反应情况。结果本组病例共16例（cT_4bN₀M₀），女性患者占多数（11/16， 68.7%），中位年龄55.4岁。随访8~104个月（中位时间41.5个月），1、3、5年LCR分别为93.7%、80%、68.7%，1、3、5年OS分别为86.7%、72%、54%；1、3、5年PFS分别为74%、53%、18.9%。9例（56.2%）患者出现不同部位器官转移，以颅内转移、肺转移常见；其中6例术前伴有颅底骨质侵犯者出现多器官转移，肿瘤侵犯颈动脉是影响远处转移的危险因素（HR=12，P=0.045）。共有8例（8/16，50%）患者出现不同程度远期放射性不良反应。结论单纯应用¹²⁵I放射性粒子植入治疗局部晚期腮腺腺样囊性癌的5年局部控制率为68.7%，肿瘤侵犯颅底骨质、包绕颈动脉是其预后不佳与发生多器官远处转移的主要因素。

英文摘要:

Objective To evaluate the efficacy of ¹²⁵I interstitial brachytherapy in the treatment of local advanced parotid adenoid cystic carcinoma (ACC), and to analyze prognostic factors affecting treatment outcome, in order to provide references for the treatment of local advanced parotid adenoid cystic carcinoma.Methods Patients with histology-confirmed ACC of the parotid who received ¹²⁵I interstitial brachytherapy in Peking University Hospital of Stomatology between Aug 2007 and Jan 2018 were included.Prognostic factors affecting overall survival (OS), progression-free survival (PFS), and local control rate (LCR) were analyzed.Meanwhile, distant metastases as well as acute and long-term radiological toxicities were described.Results A total of 16 patients (11 females, mean age 55.4 years) of stage cT_4bN₀M₀ who received definitive ¹²⁵I interstitial brachytherapy were included.The median follow-up period was 41.5 months (8-104 months),and the 1-, 3- and 5-year OS were 86.7%, 72% and 54%, respectively.Five patients suffered from local recurrence, the 1-, 3- and 5-year LCR were 93.7%, 80% and 68.7%, respectively, and the 1-, 3- and 5-year PFS were 74%, 53%, and 18.9%, respectively.Nine cases developed distant metastases.Among them, intracranial and pulmonary metastases took place the most frequently and six patients who had skull base invasion developed multi-organ metastases.An encased carotid artery was an independent prognostic factor for distant metastases (HR=12, P=0.045). Severe radiological toxicities were observed in eight patients (8/16, 50%), including radio-dermatitis, hearing loss, progressive trismus, and eye toxicities.Conclusions The 5-year LCR in patients treated with definitive ¹²⁵I interstitial brachytherapy for local advanced ACC of the parotid was 68.7%, and skull base invasion and an encased carotid artery were independent adverse prognostic factors of bad prognosis and multi-organ metastases.

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