摘要
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1．31×10^7～2．96×10^7 Bq（0．3～0．8mCi）的粒子，CT及B超双引导下植入，术后24h内CT扫描，剂量验证D90为80～120Gy。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。
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 eases 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 × 10^7-2.96 × 10^7 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 125^Ⅰ seeds has more reliable effect in relieving pain, less complication and faster onset of action.
出处
《中华实验外科杂志》
CAS
CSCD
北大核心
2014年第6期1348-1350,共3页
Chinese Journal of Experimental Surgery
基金
河北省科学技术厅支撑计划资助项目（11276103D-34）
