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山东大学学报（医学版） ›› 2017, Vol. 55 ›› Issue (2): 32-37.doi: 10.6040/j.issn.1671-7554.0.2016.1487

• 放射性粒子植入治疗肿瘤专题 • 上一篇    下一篇

CT引导下125I粒子植入治疗Ⅲ期非小细胞肺癌疗效与并发症的临床观察

戴建建,袁冰,张颖,林琦,袁苑,韩明勇   

  1. 山东大学附属省立医院东院保健综合(肿瘤)科, 山东 济南 250014
  • 收稿日期:2016-11-12 出版日期:2017-02-10 发布日期:2017-02-10
  • 通讯作者: 韩明勇. E-mail:hanmingyong@sina.com E-mail:hanmingyong@sina.com
  • 基金资助:
    国家自然科学基金(81272351)

CT-guided percutaneous 125I seed implantation brachytherapy in patients with stage Ⅲ non-small-cell lung cancer

DAI Jianjian, YUAN Bing, ZHANG Ying, LIN Qi, YUAN Yuan, HAN Mingyong   

  1. Department of Health Oncology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250014, Shandong, China
  • Received:2016-11-12 Online:2017-02-10 Published:2017-02-10

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摘要： 目的 观察CT引导下125I粒子植入治疗在Ⅲ期非小细胞肺癌患者中的疗效及并发症。 方法 回顾性分析19例行CT引导下125I粒子植入治疗的Ⅲ期原发性非小细胞肺癌患者的临床资料。术前行胸部增强CT扫描,明确肿瘤部位、大小、与周围脏器毗邻关系,血液学检查排除凝血及肝肾功能异常。术前依据肿瘤CT影像,采用治疗计划系统(TPS)制定治疗计划,处方剂量(PD)为120 Gy。于CT引导下行经皮125I粒子植入治疗。手术均在局部麻醉下进行。术后1、3、6个月行胸部增强CT扫描随访。根据实体肿瘤疗效评价标准评估疗效。 结果 19例患者的中位肿瘤体积为20 cm3。术后1个月局部控制率(CR+PR+SD)为94.7%(18/19),术后2个月局部控制率为94.7%(18/19),术后5个月局部控制率为87.5%(14/16),术后7个月局部控制率为83.3%(10/12),术后8、9个月局部控制率分别为85.7%、83.3%。中位随访时间7个月(4~24个月),中位局部进展时间7个月(2~21个月)。所有患者均无近期严重并发症出现,轻度并发症包括肺内出血7例,皮下血肿1例,轻度气胸1例、中大量气胸行胸腔闭式引流5例,迟发性气胸1例,咯血3例,皮下气肿1例。 结论 CT引导下经皮125I粒子植入治疗Ⅲ期非小细胞肺癌的局部控制效果较好,与操作相关的并发症较少,操作相对安全,可作为不能手术的非小细胞肺癌的一种辅助治疗手段。

关键词: 非小细胞肺癌, 近距离照射治疗, 125I粒子, 计算机断层扫描

Abstract: Objective To assess the efficacy and complications of CT-guided percutaneous 125I seed implantation brachytherapy in the treatment of stage Ⅲ non-small-cell lung cancer(NSCLC). Methods Clinical date of 19 stage Ⅲ NSCLC cases were retrospectively analyzed. All cases were pathologically confirmed. The median age of patients was 57 years. Preoperative chest enhanced CT scan was performed to show the location and size of the tumor and its relation with surrounding organs. Hematologic studies were conducted to exclude patients with coagulant or hepatic and renal function abnormality. The treatment planning system(TPS)was used preoperatively to calculate the estimated seed number and distribution. The prescription dose(PD)was 120 Gy. 125I seeds were implanted percutaneously under CT guidance and local anesthesia. Follow-up CT scan was performed 1, 3 and 6 months after surgery. Therapeutic effect was evaluated according to response evaluation criteria in solid tumors(RECIST). Results The median volume of tumors was 20 cm3. Local tumor control rate(CR+PR+SD)was 94.7%(18/19), 94.7%(18/19), 87.5% 山 东 大 学 学 报 (医 学 版)55卷2期 -戴建建,等.CT引导下125I粒子植入治疗Ⅲ期非小细胞肺癌疗效与并发症的临床观察 \=-(14/16), 83.3%(10/12), 85.7%(6/7)and 83.3%(5/6)1, 2, 5, 7, 8 and 9 months after operation. The median follow-up was 7 months(4-24), and the median time to progression was 7 months(2-21). No major complications were observed. Minor complications included pulmonary hemorrhage(n=7, 37%), subcutaneous hematoma(n=1, 5%), mild pneumothorax(n=1, 5%), closed drainage of thoracic cavity(n=5, 26%), late-onset pneumothorax(n=1, 5%), hemoptysis(n=3, 16%), and subcutaneous emphysema(n=1, 5%). Conclusion Safe and effective, CT-guided percutaneous 125I seed implantation brachytherapy can serve as an adjuvant option in the treatment of stage Ⅲ NSCLC.

Key words: 125I seed, Non-small-cell lung cancer, Computed tomography, Brachytherapy

中图分类号: 

  • R730.55
[1] Siegel RL, Miller KD, Jemal A. Cancer statistics, 2016[J]. CA Cancer J Clin, 2016, 66(1): 7-30.
[2] 殷蔚伯, 余子豪, 徐国镇, 等. 肿瘤放射治疗学[M]. 4版. 北京: 中国协和医科大学出版社, 2008: 578-579.
[3] Li J, Yu M, Xiao Y, et al. Computed tomography fluoroscopy-guided percutaneous 125I seed implantation for safe, effective and real-time monitoring radiotherapy of inoperable stage T1-3N0M0 non-small-cell lung cancer[J]. Mol Clin Oncol, 2013, 1(6): 1019-1024.
[4] Xiang Z, Li G, Liu Z, et al. 125I Brachytherapy in locally advanced nonsmall cell lung cancer after progression of concurrent radiochemotherapy[J]. Medicine(Baltimore), 2015, 94(49): e2249. doi: 10.1097/MD.0000000000002249.
[5] Huo X, Wang H, Yang J, et al. Effectiveness and safety of CT-guided 125I seed brachytherapy for postoperative locoregional recurrence in patients with non-small cell lung cancer[J]. Brachytherapy, 2016, 15(3):370-380.
[6] 梁吉祥, 柴树德, 郑广钧, 等. CT引导下植入125I粒子治疗非小细胞肺癌切除术后局部复发的疗效[J]. 国际放射医学核医学杂志, 2011, 35(3): 181-185. LIANG Jixiang, CHAI Shude, ZHENG Guangjun, et al. CT-guided percutaneous interstitial implantation of 125I for recurrent patients of postoperative non-small cell lung carcinoma[J]. Int J Radiat Med Nucl Med, 2011, 35(3): 181-185.
[7] Wang ZM, Lu J, Liu T, et al. CT-guided interstitial brachytherapy of inoperable non-small cell lung cancer[J]. Lung Cancer, 2011,74(2): 253-257.
[8] 胡建林, 杨和平, 李前伟, 等, 经皮穿刺瘤体内植入125I粒子治疗肺癌的初步评价[J]. 重庆医学, 2002, 3(9): 774-775.
[9] 王锡明, 李振家, 武乐斌, 等. CT引导下组织间置入125I粒子治疗肺癌的临床应用[J]. 中华放射学杂志, 2005, 39(5): 490-492. WANG Ximing, LI Zhenjia, WU Lebin, et al. The clinical application of CT-guided interstitial 125I seeds implantation in curing lung cancer[J]. Chin J Radiol, 2005, 39(5): 490-492.
[10] Xiang Z, Mo Z, Li G, et al. 125I brachytherapy in the palliation of painful bone metastases from lung cancer after failure or rejection of conventional treatments[J]. Oncotarget, 2016, 7(14): 18384-18393.
[11] Yu X, Li J, Zhong X, et al. Combination of Iodine-125 brachytherapy and chemotherapy for locally recurrent stage Ⅲ non-small cell lung cancer after concurrent chemoradiotherapy[J]. BMC Cancer, 2015,15: 656. doi: 10.1186/s12885-015-1657-3.
[12] 齐丽萍, 张晓鹏, 唐磊, 等. 扩散加权成像用于中央型肺癌与肺不张鉴别的初步研究[J]. 中国医学影像技术, 2007, 23(10): 1486-1490. QI Liping, ZHANG Xiaopeng, TANG Lei, et al. Diffusion-weighted MR imaging for differentiation diagnosis of central lung cancer from postobstructive lobar collapse-preliminary study[J]. Chinese Journal of Medical Imaging Technology, 2007, 23(10): 1486-1490.
[13] Konert T, Vogel WV, Everitt S, et al. Multiple training interventions significantly improve reproducibility of PET/CT-based lung cancer radiotherapy target volume delineation using an IAEA study protocol[J]. Radiother Oncol, 2016, 121(1): 39-45.
[14] Fleckenstein J, Jelden M, Kremp S, et al. The impact of diffusion-weighted MRI on the definition of gross tumor volume in radiotherapy of non-small-cell lung cancer[J]. PLoS One, 2016, 11(9): e0162816. doi: 10.1371/journal.pone.0162816. eCollection.
[15] Cron GO, Beghein N, Crokart N, et al. Changes in the tumor microenvironment during low-dose-rate permanent seed implantation iodine-125 brachytherapy[J]. Int J Radiat Oncol Biol Phys, 2005, 63(4): 1245-1251.
[16] Huo X, Wang H, Yang J, et al. Effectiveness and safety of CT-guided 125I seed brachytherapy for postoperative locoregional recurrence in patients with non-small cell lung cancer[J]. Brachytherapy, 2016, 15(3): 370-380.
[17] Li JR, Sun Y, Liu L. Radioactive seed implantation and lobaplatin chemotherapy are safe and effective in treating patients with advanced lung cancer[J]. Asian Pac J Cancer Prev, 2015, 16(9): 4003-4006.
[18] 胡效坤, 王明友, 杨志国, 等. CT导引下经皮穿刺组织间植入125I放射微粒子治疗中心型肺癌的应用研究[J]. 中华放射学杂志, 2004, 38(9): 910-914. HU Xiaokun, WANG Mingyou, YANG Zhiguo, et al. The study of curing central-type lung cancer by CT guided percutaneous embedding of 125I seeds[J].Chin J Radiol, 2004, 38(9): 910-914.
[19] 吕金爽, 郑广钧, 杨景魁, 等. CT引导下125I放射性粒子植入治疗肺癌纵隔淋巴结4R组转移进针路径的临床研究[J/CD]. 中华临床医师杂志, 2012, 6(16): 4659-4662. LÜ Jinshuang, ZHENG Guangjun, YANG Jingkui, et al. The clinical study of the puncture paths in treating 4R mediastinal lymph node metastasis of lung cancer by implantation of 125I radioactive seeds[J/CD]. Chin J Clinicians(Electronic Edition), 2012, 6(16): 4659-4662.
[20] 霍小东, 杨景魁, 闫卫亮, 等. CT引导下125I粒子植入治疗肺癌术后气胸发生率的相关因素分析[J]. 中华放射医学与防护杂志, 2014, 34(12): 912-915. HUO Xiaodong, YANG Jingkui, YAN Weiliang, et al. The factor analysis of the incidence of pneumothorax after CT Guided 125I radioactive seed implantation for lung cancer[J]. Chin J Radiol Med Prot, 2014, 34(12): 912-915.
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