摘要
目的探讨CT引导下放射性^(125)Ⅰ粒子组织间植入治疗复发直肠癌的技术可行性、疗效和副反应。方法23例直肠癌术后复发患者行CT引导下^(125)Ⅰ粒子植入术,其中3例行2次粒子植入。20例手术采用硬膜外麻醉,3例局部麻醉。20例腹卧位,3例仰卧位。术前通过治疗计划系统行三维治疗计划,确定粒子数目、空间分布和粒子针数目。既往放疗者肿瘤匹配周边剂量为90～120 Gy,未行放疗者为140～160 Gy。治疗PTV为CTV外加1 cm。粒子活度18．5～25．9MBq(0．5～0．7mCi)。植入粒子33～137颗,术后即刻行CT扫描进行质量验证。术后1周3例患者加三维适形放疗,2～3 Gy/次,总剂量45～50 Gy。每3个月复查1次CT。结果随访3～28个月。术后平均7 d疼痛缓解,其中完全缓解12/15,部分缓解2/15,无变化1/15,总有效率为93%。肿瘤局部控制率为87%。中位生存时间14个月,1、2年生存率分别为93%和50%。4例全身合并全身转移,2例8个月和12个月时死于肺转移。无治疗相关严重并发症发生。结论CT引导放射性^(125)Ⅰ粒子植入治疗复发直肠癌具有安全、微创、并发症率低和疗效肯定等优势,疗后配合外放疗和全身化疗有望进一步提高疗效。
Objective To investigate the technological feasibility, efficacy and morbidity of CT guided ^125I seed implantation for recurrent rectum cancer. Methods Twenty-three patients with recurrent rectum cancer were treated with CT guided interstitial ^125I seed brachytherapy. In 20 patients the procedure was performed trader epidural anesthesia and 3 patients trader local anesthesia. Treatment planning system was used to calculate the number of seeds, the space distribution and the introduction of the seeding needles. Matched peripheral dose （MPD） of ^125I seed implantation ranged from 90-120 Gy for patients who had had external radiotherapy, and 140- 160Gy for those who had not. The planning target volume（PTV） was clinical target volume（CTV） plus 1 cm margin. The range of radioactivity of the ^125I seeds was 18.5-25.9 MBq. All these 23 patients had CT scan at 5 mm intervals after implantation for quality evaluation, together with routine chest, pelvic X-ray fdms within 24-48 hours after seed implantation. Three patients received three-dimensional conformal radiation therapy（3DCRT） to a total dose of 45-50 Gy, with 2-3 Gy/f. Follow-up time was from 3 to 28 months. Results All patients was able to tolerate seed implantation well. Complete pain relief was observed in 12/15, and partial relief in 2/15 and no response in 1/15, with a response rate of 93%. The local control rate was 87%. The 1- and 2-year survival rate was 93 % and 50% respectively. Two of four patients have died of dissemination to the lung after 8 and 12 months. One seed has migrated into the pelvis without causing any untoward morbidity. Conclusion CT guided 1251 seed implantation for recurrent rectum cancer is safe, minimally invasive, causing only mild morbidity. It possesses a high efficacy, yet it should be given in combination with external beam radiation and chemotherapy, should distant metastasis be observed.
出处
《中华放射肿瘤学杂志》
CSCD
北大核心
2006年第4期319-322,共4页
Chinese Journal of Radiation Oncology
关键词
直肠肿瘤/放射疗法
肿瘤复发
粒子
植入
碘放射性同位素
Rectum neoplasms/radiotherapy
Neoplasm recurrence
Particles, pellets
Iodine radioisotopes
