七年的随访显示，一名患有唇鳞状细胞癌和阿尔茨海默病的老年患者在接受125I粒子近距离放疗后获得持续生存：一例病例报告

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中文摘要

唇鳞状细胞癌是口腔恶性肿瘤的一种独特亚型。手术切除可提供满意的局部肿瘤控制；然而，它常常损害口腔功能、降低局部感觉并毁损面部轮廓——这些后遗症在患有多种合并症的老年患者中尤为严重。本研究报道了一例80岁患有阿尔茨海默病的女性，表现为局部晚期唇鳞状细胞癌（cT3N2bM0，IVA期）和颈部淋巴结转移。经过多学科团队评估，该患者被认为不适合接受根治性手术切除或确定性外照射放疗。因此，在三维（3D）打印模板辅助下，对原发唇部肿瘤和转移性颈部淋巴结进行了计算机断层扫描（CT）引导的放射性125I粒子植入，处方剂量为140 Gy。术后剂量学验证确认靶区体积覆盖充分。患者获得了持久的临床完全缓解，肿瘤显著消退，言语和吞咽功能得以保留，并且总生存期超过7年，目前仍存活。本病例证明了上述微创方法在患有严重认知障碍的老年患者中的长期疗效和安全性——这一人群通常被排除在前瞻性试验之外。随访期间未记录到任何放射性毒性，包括口干症或放射性骨坏死。这些发现表明，CT引导的125I粒子近距离放疗联合3D打印模板是一种可行、保留功能且可能具有根治性的治疗选择，适用于经过仔细筛选、无法耐受常规确定性治疗的晚期唇鳞状细胞癌老年患者。这些结果进一步挑战了介入近距离放疗仅作为姑息治疗措施的常见观点。

英文摘要

Lip squamous cell carcinoma is a distinct subtype of oral malignancy. Surgical resection provides satisfactory local tumor control; however, it frequently compromises oral function, diminishes local sensation and disfigures facial contour-sequelae are disproportionately debilitating in elderly patients with multimorbidity. This study reported the case of an 80-year-old woman with Alzheimer's disease who presented with locally advanced lip squamous cell carcinoma (cT3N2bM0, stage IVA) and cervical lymph node metastases. Following multidisciplinary team evaluation, the patient was deemed unsuitable for curative surgical resection or definitive external-beam radiotherapy. Therefore, computed tomography (CT)-guided radioactive 125I seed implantation, assisted by a three-dimensional (3D) printed template, was performed for both the primary lip tumor and the metastatic cervical nodes, with a prescribed dose of 140 Gy. Postprocedural dosimetric verification confirmed adequate target volume coverage. The patient achieved a durable clinical complete response, with remarkable tumor regression, preserved speech and swallowing function, and remains alive with overall survival exceeding 7 years. This case demonstrates the long-term efficacy and safety of the aforementioned minimally invasive approach in an elderly patient with severe cognitive impairment-a population routinely excluded from prospective trials. No radiation-related toxicities, including xerostomia or osteoradionecrosis, were documented during follow-up. These findings indicate that CT-guided 125I seed brachytherapy with 3D-printed templates is a feasible, function-preserving and potentially curative treatment option for carefully selected elderly patients with advanced lip squamous cell carcinoma who are unable to tolerate conventional definitive therapy. These results further challenge the common view that interventional brachytherapy serves only as a palliative measure.