【正文】 uamous cell cancer of the head and neck. Laryngoscope, 1991,101:40541011 .Harrison LB. Application of brachytherapy in head and neck cancer. Seminars Surgical Oncology,1997,13:17718412 .Matsumoto S, Takeda M, Shibuya H, et al. T1 and T2 squamous cell carcinomas of the floor of the mouth: results of brachytherapy mainly using 198Au grains. Int J Radiat Oncol Biol Phys, 1996, 34:833841二、胸部腫瘤 適應(yīng)證：（1）非小細胞肺癌：①非手術(shù)適應(yīng)證患者；②直徑＜7cm。（2）小細胞肺癌：對放化療不明敏感的小細胞肺癌或放化療后復(fù)發(fā)的可試用。（3）肺轉(zhuǎn)移癌：①單側(cè)肺病灶數(shù)目3個；②如為雙側(cè)病灶，每側(cè)病灶數(shù)目3個，且應(yīng)分次治療。粒子活度：～推薦粒子劑量：（1）單純粒子治療MPD：90Gy～110Gy；（2）聯(lián)合外照射酌情減量。治療原則： （1） CT掃描探測腫瘤大小，確定進針方向。（2） CT引導(dǎo)下插植粒子植入導(dǎo)針，間距1cm～，～1cm。粒子植入導(dǎo)針一次性插植完成。建議使用模板，確保粒子治療精度。（3） 粒子植入后即刻驗證。（4） 必要時補充外照射。（5） 根據(jù)腫瘤分期決定是否聯(lián)合化療。注意事項：（1）經(jīng)皮穿刺粒子植入治療需要借助CT引導(dǎo)，術(shù)中可以采用彩色超聲引導(dǎo)。（2）～1cm。（3）粒子距離血管、大氣管1cm以上。（4）既往有外照射史者慎用。（5）推薦實施術(shù)后質(zhì)量驗證。（6）應(yīng)根據(jù)腫瘤的病理學(xué)類型、分期和患者身體一般狀況決定是否聯(lián)合外照射或化療。參考文獻1. Imamura F, Chatani M, Nakayama T, et al. Percutaneous brachytherapy for smallsized nonsmall cell lung cancer. Lung Cancer, 1999。 24:1691742. Lee W, Daly B, Dipetrillo T, et resection for nonsmall cell lung cancer: observed local control with implantation of I125 brachytherapy Thorac Surg, 2003。 75:2372433. Rafael Mart. Percutaneous CTguided 103Pd implantation for the medically inoperable patient with T1N0M0 nonsmall cell lung cancer: A case report. Brachytherapy，2004。3(3):1791814. Santos R, Colonias A, Parda D, et al. Comparison between sublobar resection and 125Iodine brachytherapy after sublobar resection in highrisk patients with stage I nonsmallcell lung cancer. Surgery, 2003。 134:691–6975. Rafael Mart237。nezMongea. CTguided permanent brachytherapy for patients with medically inoperable earlystage nonsmall cell lung cancer (NSCLC) .Lung Cancer, 2008 6. Nag S, Kelly JF, Horton JL, et al. Brachytherapy for carcinoma of the lung. Remendations from the American Brachytherapy ,2001。15:371381.7. Alex chen. Intraoperative 125I brachytherapy for highrisk stage I nonsmall cell lung carcinoma. Int J Radiat oncol Biol Phys, 1999。44:1057–10638. Williamson JF, Coursey BM, Dewerd la, et al. On the use of apparent activity (AAPP) for treatment planning of 125i and 103Pd interstitial brachytherapy sources: remendations of the American Association of Physicists in medicine radiation therapy submittee on lowenergy brachytherapy source dosimetry. Med phys 1999。26:2529–2530.9. Voynov1 G, Heron1 D E, Lin CJ. Intraoperative 125I Vicryl mesh brachytherapy after sublobar resection for highrisk stage I nonsmall cell lung cancer. Brachytherapy, 2005。4:278–28510. Uematsu M, Shioda A, Suda A, et al. Computed tomography–guided frameless stereotactic radiotherapy for stage I nonsmall cell lung cancer: A 5year experience. Int J Radiat Oncol Bio Phys ,2001。51:666–670.11. Rafael Mart253。180。nezMonge1, Cristina Garra180。n1, Isabel Vivas, et al. Percutaneous CTguided 103Pd implantation for the medically inoperable patient with T1N0M0 nonsmall cell lung cancer: A case report. Brachytherapy, 2004。179–181.12. Nori D, Li X, Pugkhem T. Intraoperative brachytherapy using Gelfoam radioactive plaque implants for resected stage III nonsmall cell lung cancer with positive margin: A pilot study. J Surg Oncol, 1995。60:257–26113. Thomas J. Birdas, Richard PM, et al. Sublobar resection with brachytherapy versus lobectomy for stage Ⅰb nonsmall cell lung cancer. Ann Thorac Surg, 2006。81:43443914. Winnie Lee, Benedict DT, Daly TA, et al. Limited resection for non–small cell lung cancer: observed local control with implantation of I125 brachytherapy seeds. Ann Thorac Surg, 2003。75:237–24315. Nag S, Kelly JF, Nori D. Brachytherapy for carcinoma of the lung. Oncology (Huntington),2001。15:37138116. D’Amato TA, Galloway M, Szydlowaki G, et al. Intraoperative brachytherapy following thoracoscopic wedge resection of stage I lung cancer. Chest, 1998。114:1112111517. Julianna P, Scott J, Belsley. Placement of 125I implants with the da vinci robotic system after videoassisted thoracoscopic wedge resectio