CT引导下碘125粒子植入治疗55例腹膜后恶性肿瘤的临床观察

doi:10.6040/j.issn.1671-7554.0.2019.1198

摘要/Abstract

摘要： 目的评估CT引导下碘125(¹²⁵I)放射性粒子植入治疗腹膜后恶性肿瘤的有效性及安全性。方法纳入腹膜后肿瘤患者55例,病灶69处,均为无法手术、术后复发或转移,接受CT引导下¹²⁵I粒子植入治疗。术前1周内行CT检查,应用治疗计划系统勾画出肿瘤靶区轮廓,确定粒子数量、粒子空间排布方式和植入针数目。CT引导下行¹²⁵I粒子植入治疗。术后每2个月随访1次,评估病灶局部控制率、疼痛缓解情况及治疗相关不良反应。结果所有病灶均成功接受CT引导下¹²⁵I粒子植入治疗。首次治疗后2个月CT扫描结果显示,69处病灶中完全缓解9处,部分缓解18处,病灶稳定36处,疾病进展6处,总体病灶治疗有效率39.1%,局部控制率91.3%。术后4、6个月,总体病灶治疗有效率分别为40.6%、37.7%,局部控制率分别为89.9%、87.0%。24例患者术前存在腰背及腹部疼痛症状,术后7 d再次评估,12例(50%)患者的疼痛症状得到缓解。没有出现治疗相关的死亡事件,15例(27.3%)患者表现为术后穿刺部位疼痛,其中1例疼痛较重,给予镇痛药物治疗后缓解,其他均可自行缓解;未出现出血、肠瘘、放射性肠炎、骨髓抑制等并发症。结论 CT引导下¹²⁵I粒子植入治疗腹膜后恶性肿瘤是安全、有效的,对于无法手术、术后复发或转移的腹膜后肿瘤是一种挽救性的治疗措施。

关键词: 腹膜后肿瘤, ¹²⁵I放射性粒子, 介入放射学, 肿瘤介入, 近距离放疗

Abstract: Objective To evaluate the efficacy and safety of CT-guided ¹²⁵I seeds implantation for the treatment of retroperitoneal malignant tumors. Methods A total of 55 patients with 69 lesions, which were unresectable, postoperative recurrent or metastatic, received ¹²⁵I seeds implantation under CT guidance. CT scan was performed within 1 week before the implantation. The contour of tumor target area was outlined with the treatment planning system, and the required radiation dose, number of seeds and spatial arrangement were calculated. Then CT-guided ¹²⁵I seeds implantation was performed. Follow-up was carried out at an interval of 2 month to evaluate the disease control rate, pain relief rate and treatment-related adverse events. Results All operations were successful. CT images 2 months after implantation showed complete response, partial response, stable disease and progressive disease in 9, 18, 36 and 6 lesions, respectively. The overall response rate was 39.1%, and local control rate was 91.3%. The overall response rate was 40.6% and 37.7%, and local control rate was 89.9% and 87.0%, respectively, 4 and 6 months after operation. In the 24 patients who had back or abdominal pain,12(50%)cases were relieved 7 days after the implantation. No treatment-related death occurred. Pain at puncture site was observed in 15 patients(27.3%), and only 1 patient need analgesic treatment to relieve. No complications, such as bleeding, intestinal fistula, radiation enteritis, or bone marrow suppression, were observed. Conclusion CT-guided ¹²⁵I seeds implantation is safe and effective for the treatment of malignant retroperitoneal tumors. For patients with unresectable, postoperative recurrent or metastatic retroperitoneal tumors, CT-guided ¹²⁵I seeds implantation may be a salvage strategy.

Key words: Retroperitoneal tumor, Iodine-125 radioactive seed, Interventional radiology, Tumor intervention, Brachytherapy

中图分类号:

R815

王浩,陆建,陈荔,查俊豪,郭金和. CT引导下碘125粒子植入治疗55例腹膜后恶性肿瘤的临床观察[J]. 山东大学学报 (医学版), 2020, 58(6): 65-70.

WANG Hao, LU Jian, CHEN Li, ZHA Junhao, GUO Jinhe. CT-guided ¹²⁵I seeds implantation for the treatment of malignant retroperitoneal tumor: an analysis of 55 cases[J]. Journal of Shandong University (Health Sciences), 2020, 58(6): 65-70.

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