放射性125I粒子植入近距离治疗长骨转移瘤的临床疗效

doi:10.6040/j.issn.1671-7554.0.2016.1239

摘要/Abstract

摘要： 目的探讨放射性¹²⁵I粒子植入近距离治疗长骨转移瘤的临床疗效。方法回顾性收集18例(23处长骨转移病变)长骨转移瘤患者的完整临床及影像学资料,23处病变中,位于肱骨者8处,股骨14处,腓骨1处。应用疼痛数字评分(NRS)及美国肌肉骨骼肿瘤学会评分系统标准(MSTS)评分,对术前术后疼痛、功能情况进行评价。结果本组治疗靶区23个,治疗靶区体积(GTV)为(29.25±22.06)cc,植入粒子数27(15,36),粒子活度0.8 mCi,术后验证剂量D90(11 538.1±1 888.6)cGy,治疗后随访3~48个月,中位随访时间9个月。NRS评分、MSTS评分在3个月随访期内均有改善(P<0.001, P<0.05)。中位生存时间为10个月,6、12、24个月生存率分别为70.8%、41.3%、23.6%。结论放射性¹²⁵I粒子植入治疗长骨转移瘤能减轻患者局部疼痛,改善患者功能状态,是一种有效的姑息性治疗方法。

关键词: X线计算机, 放射性¹²⁵I粒子, 体层摄影术, 长骨转移瘤, 近距离治疗

Abstract: Objective To evaluate the clinical efficacy of the implantation of ¹²⁵I radioactive seeds in the treatment of long bone metastasis. Methods The clinical data of 18 cases were collected along with their imaging data. The lesions located in the humerus(n=8), thighbone(n=14), and fibula(n=1). The patients pain was observed by using the numerical rating scale(NRS), and the functions of patients were investigated with the Musculoskeletal Tumor Society(MSTS)scoring system before and after surgery. The survival rate was described with Kaplan-Meier survival curve. Results All of the 23 radiotherapy targets were implanted with ¹²⁵I seeds. The gross tumor volume(GTV)was(29.25±22.06)cc, and the radioactive activity of seed was 0.80 mCi. Median number of seeds implanted in lesions was 27(15, 36). The postoperative target verified dose D90 was(11 538.1±1 888.6)cGy. The mean follow-up was 9 months(ranging from 3 to 48 months).The NRS and MSTS scores were both improved significantly during the follow-up(P<0.001, P<0.05). Medium survival time was 10 months, while the survival rate for 6, 12 and 24 months was 70.8%, 41.3% and 23.6%, respectively. Conclusion CT-guided ¹²⁵I seed implantation is an effective and safe palliative care for long bone metastasis, which can effectively relieve the pain and improve the functions of patients.

Key words: ¹²⁵I radioactive seeds, Brachytherapy, Long bone metastasis, X-ray computed, Tomography

中图分类号:

R739.93

李扬,何闯,陈玉潇,杨丽,李良山,李廷源,黄学全. 放射性¹²⁵I粒子植入近距离治疗长骨转移瘤的临床疗效[J]. 山东大学学报（医学版）, 2017, 55(2): 50-54.

LI Yang, HE Chuang, CHEN Yuxiao, YANG Li, LI Liangshan, LI Tingyuan, HUANG Xuequan. CT-guided interstitia ¹²⁵I seed implantation in the treatment of long bone metastasis: a primary clinic study[J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2017, 55(2): 50-54.

参考文献

[1] Wang Z, Wen X, Lu Y, et al. Exploiting machine learning for predicting skeletal-related events in cancer patients with bone metastases[J]. Oncotarget, 2016, 7(11): 12612-12622.
[2] Tsuzuki S, Park SH, Eber MR, et al. Skeletal complications in cancer patients with bone metastases[J]. Int J Urol, 2016, 23(10): 825-832.
[3] Wood TJ, Racano A, Yeung H, et al. Surgical management of bone metastases: quality of evidence and systematic review[J]. Ann Surg Oncol, 2014, 21(13): 4081-4089.
[4] Costelloe CM, Chuang HH, Madewell JE, et al. Cancer response criteria and bone metastases: RECIST 1.1, MDA and PERCIST[J]. J Cancer, 2010, 1: 80-92.
[5] Van der Linden YM, Dijkstra PD, Kroon HM, et al. Comparative analysis of risk factors for pathological fracture with femoral metastases[J]. J Bone Joint Surg Br, 2004, 86(4): 566-573.
[6] Liu XW, Jin P, Liu K, et al. Comparison of percutaneous long bone cementoplasty with or without embedding a cement-filled catheter for painful long bone metastases with impending fracture[J]. Eur Radiol, 2016.[Epub ahead of print]
[7] Mirels H. Metastatic disease in long bones. A proposed scoring system for diagnosing impending pathologic fractures[J]. Clin Orthop Relat Res, 1989(249): 256-264.
[8] Jawad MU, Scully SP. In brief: classifications in brief: Mirels classification: metastatic disease in long bones and impending pathologic fracture[J]. Clin Orthop Relat Res, 2010, 468(10): 2825-2827.
[9] 汪阳, 张卫国, 蒋林, 等. 髓内钉系统结合骨水泥填充治疗老年股骨转移瘤致股骨病理骨折[J]. 临床急诊杂志, 2015, 16(4): 263-264. WANG Yang, ZHANG Weiguo, JIANG Lin, et al. Intramedullary nail in treatment of elderly patients with metastases to fill the pathological femoral fractures with bone cement[J]. Journal of Clinical Emergency, 2015, 16(4): 263-264.
[10] Ward WG, Spang J, Howe D. Metastatic disease of the femur. surgical management[J]. Orthop Clin North Am, 2000, 31(4): 633-645.
[11] 吴宗明, 唐献忠, 杨庆诚. 四肢骨转移癌126例手术疗效分析[J].中国骨与关节杂志, 2015, 4(5): 343-347. WU Zongming, TANG Xianzhong, YANG Qingcheng. Clinical results in surgical treatment of bone metastases in limbs: 126 cases report[J]. Chinese Journal of Bone and Joint, 2015, 4(5): 343-347.
[12] Keung EZ, Fairweather M, Raut CP. Surgical management of metastatic disease[J]. Surg Clin North Am, 2016, 96(5): 1175-1192.
[13] McDonald R, Probyn L, Poon I, et al. Tumor response after stereotactic body radiation therapy to nonspine bone metastases: an evaluation of response criteria[J]. Int J Radiat Oncol Biol Phys, 2015, 93(4): 879-881.
[14] Westhoff PG, Verdam MG, Oort FJ, et al. Course of quality of life after radiation therapy for painful bone metastases: a detailed analysis from the dutch bone metastasis study[J]. Int J Radiat Oncol Biol Phys, 2016, 95(5): 1391-1398.
[15] 王俊杰, 张福君. 肿瘤放射性粒子治疗规范[M]. 北京: 人民卫生出版社, 2016: 143.
[16] Kouloulias V, Liakouli Z, Zygogianni A, et al. Bone density as a marker of response to radiotherapy in bone metastatic lesions: a review of the published data[J]. Int J Mol Sci, 2016, 17(9). pii: E1391. doi: 10.3390/ijms17091391.
[17] Lutz S, Berk L, Chang E, et al. Palliative radiotherapy for bone metastases: an ASTRO evidence-based guideline[J]. Int J Radiat Oncol Biol Phys, 2011, 79(4): 965-976.
[18] 李锦新, 张启周, 栗国梁. ¹²⁵I放射性粒子植入治疗骨转移瘤的临床观察[J]. 影像诊断与介入放射学, 2011, 20(1): 55-57. LI Jinxin, ZHANG Qizhou, LI Guoliang. Clinical application of permanent implantation of iodine 125 seeds for osseous metastases[J]. Diagnostic Imaging & Interventional Radiology, 2011, 20(1): 55-57.
[19] 徐绍年, 李福生, 杜振广, 等. ¹²⁵I粒子组织间植入治疗骨转移瘤的临床研究[J]. 中国骨肿瘤骨病, 2011, 10(4): 338-342. XU Shaonian, LI Fusheng, DU Zhenguang, et al. Interstitial ¹²⁵I seeds implantation in the treatment of osseous metastasis[J]. Chin J Bone Tumor & Bone Disease, 2011, 10(4): 338-342.
[20] Yang Z, Tan J, Zhao R, et al. Clinical investigations on the spinal osteoblastic metastasis treated by combination of percutaneous vertebroplasty and(125)I seeds implantation versus radiotherapy[J]. Cancer Biother Radiopharm, 2013, 28(1): 58-64.
[21] Tatar Z, Soubrier M, Dillies AF, et al. Assessment of the risk factors for impending fractures following radiotherapy for long bone metastases using CT scan-based virtual simulation: a retrospective study[J]. Radiat Oncol, 2014, 9: 227. doi: 10.1186/s13014-014-0227-1.
[22] Saad F, Lipton A, Cook R, et al. Pathologic fractures correlate with reduced survival in patients with malignant bone disease[J]. Cancer, 2007, 110(8): 1860-1867.
[23] Ratasvuori M, Wedin R, Keller J, et al. Insight opinion to surgically treated metastatic bone disease: Scandinavian Sarcoma Group Skeletal Metastasis Registry report of 1195 operated skeletal metastasis[J]. Surg Oncol, 2013, 22(2): 132-138.

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放射性¹²⁵I粒子植入近距离治疗长骨转移瘤的临床疗效

CT-guided interstitia ¹²⁵I seed implantation in the treatment of long bone metastasis: a primary clinic study

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