摘要
目的探讨CT导向下^125I粒子植入治疗复发／转移性盆腔恶性肿瘤的近中期临床疗效。方法接受手术、化疗或放疗等综合治疗后盆腔复发／转移恶性肿瘤患者30例，男10例、女20例，年龄31～85岁，中位年龄为55岁。可评价病灶32个，病灶最大径3．0～12．2cm，平均值4．8cm。病例采用计算机立体定位系统（treatment plan system，TPS）计算布源，肿瘤周边匹配剂量（MPG）为100～160Gy，局部麻醉CT导向下采用2．96×10^7Bq活度的^125I粒子相隔0．5～1．0cm植入盆腔病灶内，随访观察局部控制率，总体生存率，疼痛缓解情况及并发症。结果随访2～40个月，中位随访时间28个月，随访结束32个局部病灶评价CR10／32，PR13／32，SD5／32，PD4／32，临床受益率87．5％（CR＋PR＋SD），1年累计局部控制率为83．3％，2年累积局部控制率为62．5％；总体1年生存率87．7％，2年生存率73．1％，3年生存率45．7％，中位生存时间28个月；疼痛缓解率21／23（91．3％）。近期副反应轻微，远期副反应主要表现为3例Ⅰ-Ⅱ级放射性肠炎，1例Ⅰ级放射性膀胱炎，1例下肢长期麻木感，未见大出血、急性肺栓塞、盆腔脓肿、肠瘘、肠穿孔、窦道等严重并发症。结论CT导向下放射性粒子植入复发／转移性盆腔恶性肿瘤，并发症发生率低，患者生活质量改善明显，临床疗效确切，是一种治疗复发／转移性盆腔恶性肿瘤简单、安全、有效的方法。
Objective To investigate the Short- and medium-term clinical effects of clinical value of CT guided radioactive seed ^125I implantation in treating recurrent/metastatic malignant pelvic tumors. Methods 30 patients （ 10 males and 20 females, the age ranges from 31 to 85, median 55 years） with recurrent/metastatic malignant pelvic tumors after combined therapy such as surgery , chemotherapy and radiotheray et al , were enrolled in this study. The total lessions were 32 and the max diameter of each lesion ranges from 3.0 cm to 12. 2 cm ,median 4. 8 cm. Under CT guidance, the operations were performed under local anesthesia and ^125I seeds of 2. 96 × 10^7 Bq were implanted into tumors at a distance of 0. 5 cm according to TPS（Treatment Plan System）,and the MPG（matched peripheral doses） was 100- 160 Gy Observate the the local control rate , overall survival rate, pain reliefs and clinical complications after 2 - 40 months followup （median 28 months）. Results After 2 -40 months follow-up （median 28 months）, 10/32 obtained CR, 13/32 obtained PR, 5/32 NC and 4/32 PD. The clinical effective rate was 87.5% （ CR ＋ PR ＋ SD 〉 2 months）. 1- and 2-year Local control rate were 83.3% and 62. 5%, and overall 1- and 2- and 3- year survival rate were 87.7% ,73. 1% and 45.7%, respectively, the median survival time was 28 months. The rate of pain relief was 21/23（91.3% ）. Complications in the long term were Grade Ⅰ - Ⅱ radioactive rectum proctitis observed in 3 cases, Grade I radioactive cystitis observed in 1 case, insensible feeling in lower limb observed in 1 case for a long time. No other severe complications such as hemorrhoea , acute pulmonary embolism, abscess, intestinal fistula, intestinal perforation, sinus tract were encountered in all patients. Conclusion CT guided radioactive seed ^125I implantation procedure can be a simple, safe and effective method in treating recurrent/metastatic malignant pelvic tumors, which can ease the pain of patients and improve the qualities of patients＇ lives and obtain good clinical effects with minimal damage and few complications.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2008年第43期3063-3067,共5页
National Medical Journal of China
基金
广东省科委课题资助项目（2006835802009）
广州市科技局计划资助项目（303041039003）
