| The morbidity rate of oral and maxillofacial malignancies accounts for5.6%of systemic malignant tumors.The number of new cases is raised yearby year. It seriously affected patient’s health, psychology and survival time.Although the comprehensive treatment was applied in the treatment ofpatients with oral and maxillofacial malignancies,a large number of datasuggested that the local recurrence was often the main cause of treatmentfailure[1]. For patients with recurrent oral and maxillofacial malignanciesunderwent comprehensive treatments including surgery and full-dose externalradiotherapy, reoperation and a new course of external radiotherapy are not toaccepted or feasible for various reasons, resulting in failed to treatment and ahigh mortality rate in patients with recurrent oral and maxillofacialmalignancies.Interstitial implantation of125I radioactive seeds for brachy therapy is amethod of treatment of permanent implantation of radioactive materials to thetarget area, which plays a role of kill tumor cells by sustained release ofradiation. This method of treatment is irradiated from the inside to the outsideof target tumors, combined with its characteristic of shorter distance of seedradiation, thus it can kill the target tumor tissue in a greater degree and hashardly no effect on the surrounding normal tissues. Currently, radioactive seedimplantation therapy is widely used in the treatment of prostate, liver and lungmalignancies, obtaining good outcomes. There were relatively few studies oninterstitial implantation of125I radioactive seeds for brachytherapy of patientswith recurrent oral and maxillofacial malignancies, especially thoseunderwent high-dose radiotherapy.Objective: To preliminarily study the application of125I radioactive seed implantation in brachytherapy of patients with recurrent oral and maxillofacialmalignancies,and explore and summarize the effectiveness and analgesiceffect of125I seed implantation therapy and its impact on immune function.Methods:36patients admitted in the Dentistry of the Fourth Hospital ofHebei Medical University from2008to2013were collected and screened.Depending on application of125I radioactive seed implantation or not, theywere divided into the experimental group and the control group for clinicalcontrolled study. Among18patients in the experimental group,10patientsunderwent chemotherapy and ultrasound-guided125I radioactive seedimplantation therapy and8patients only received125I radioactive seedimplantation therapy alone.18patients in the control group continued to begiven the standardized chemotherapy and analgesic treatment. The results ofenhanced CT scan at one week before treatment, one month, two months,three months and six months after treatment were collected. The sum of twolargest diameters of target tumors was compared for determination of theeffective rate and clinical yield rate of treatment. The1-year survival rate andprogression-free survival were observed in two groups. The results of flowimmune function test of patients underwent125I radioactive seed implantationalone in the experimental group and patients in the control group before andafter treatment for one month were collected and analyzed. The changes in thepercentage of various lymphocyte subtypes in two groups before and aftertreatment were collected and analyzed to assess the impacts of two treatmentmethods on the body’s immune function in two groups. The pains datamonitored before treatment and at one month, two months and three monthsafter treatment were analyzed for comparison of the changes in the painsbefore and after treatment in two groups. The complications after125Iradioactive seed implantation therapy were observed.Results: The total effective rates at one month, two months, three monthsand six months after treatment were44.4%,66.7%,73.3%and100%in theexperimental group, and5.5%,0%,0%and0%in the control group. Theclinical yield rates were100%in the experimental group, and27.7%,16.7%, 5.6%and0%in the control group. The total effective rates and clinical yieldrates in two groups were given statistical analysis and found to be with astatistical significance (P<0.05). During1to60months of follow-up, themedian progression-free survival was14months in the experimental groupand two months in the control group. The1-year survival rate was83.3%inthe experimental group and16.7%in the control group. The flow immunefunction test of patients underwent125I radioactive seed implantation alone inthe experimental group showed that the P values for statistical analysis ofchanges in CD4, CD8and NK cells before and after treatment were0.089,0.265and0.068, respectively, which were all greater than0.05.It wasindicated that125I radioactive seed implantation alone had no significanteffects on the body’s immune function. The results off low immune functiontest of patients in the control group before and after treatment were givenstatistical analysis, and the resulting P values were0.025,0.002and0.031,respectively, which were all lower than0.05.It was indicated that the treatmentmethod in the control group had a certain effect on immune function. The painsymptoms were relieved after treatment in two groups. The changes in thedegree of pain in two groups were given statistical analysis, P<0.001，statistically significanted. The side effects of patients underwent seedimplantation in the experimental group were observed after treatment for threemonths. After seed implantation, there were12cases of mild swelling andpains in the implanted area,4cases of mouth ulcers and one case ofxerostomia, which were relieved or disappeared after symptomatic treatment;there were two cases of color deepened local skin; there were one case ofdelayed wound healing in the patient with parotid gland adenocarcinoma, andthe wound was healed after four months by daily routine cleaning anddressing; there were no patients with seeds shifted to other parts.Conclusions:1125I radioactive seed implantation has an exact efficacy recurrent oraland maxillofacial malignancies and is a convenient, safe and effective methodof treatment with few side effects. 2125I radioactive seed implantation has a good analgesic effect oncancer pains for patients with recurrent oral and maxillofacial malignancies.3125I radioactive implantation has no significant effect on the body’simmune function in patients with recurrent oral and maxillofacialmalignancies. |
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