摘要
目的评价CT引导下放射性^(125)I粒子植入治疗盆腔及后腹膜恶性肿瘤的临床疗效。方法 23例盆腔及后腹膜恶性肿瘤患者,在CT引导下行放射性^(125)I粒子植入。粒子植入前1周行腹部或盆腔螺旋CT扫描,将图像传送到计算机三维肿瘤治疗计划系统;勾画靶区轮廓(同时勾画肿瘤周围危险器官,如膀胱、肠管、大血管等);靶区及相关轮廓三维重建;确定肿瘤靶区放射剂量、粒子数量和粒子空间排列。术后随访均设定4个月,以观察局部治疗效果、有无消化道或泌尿系等不良反应、疼痛变化情况、局部肿瘤缓解情况。结果本组23例中有16例患者术前有骶尾部或腰背部疼痛,术后5~14 d疼痛缓解,缓解率为69.6%,局部疼痛缓解近期疗效较显著。肿瘤局部控制2个月时有效率(CR+PR)为47.8%(11/23);4个月时有效率为43.5%(10/23)。患者术后随访未见腹痛、肠瘘、出血、尿痛等不良反应,也未见放射性肠炎、骨髓抑制等并发症。结论初步研究表明CT引导下经皮穿刺植入^(125)I粒子近距离内照射治疗盆腔及后腹膜肿瘤安全、局部疗效明显等优势。对于无法手术、术后复发及单纯化、放疗效果差的盆腔及后腹膜恶性肿瘤是一种有效的补救治疗措施,并有效改善患者生存质量、提高肿瘤局部控制率。
Objective To evaluate the clinical efficacy of CT-guided ^125I seed implantation in treating pelvic and retroperitoneal malignant tumors. Methods CT-guided ^125I seed implantation was carried out in 23 patients with pelvic or retroperitoneal malignant tumors. Helical CT examination of abdomen or pelvic cavity was employed in all patients one week before the treatment, the image data were transferred to a computerized three- dimensional （3-D） tumor treatment planning system （TPS） , the contour of target areas as well as the important organs around the tumor such as the bladder, bowel, large blood vessels, etc. were sketched. 3-D reconstruction of the target and the related profile was conducted. The radiation dose of target areas, the particle number and the particle space alignment were determined. The patients were followed up for 4 months to check the local treatment effect, the toxic and side effects of digestive tract and urinary system, the changes in pain and local tumor remission. Results Of the 23 patients in this series, 16 had pain in the sacrococcygeal or lower back region before treatment. After treatment pain relief was obtained within 5-14 days, the effective rate was 87.5%, the short-term improvement for local pain was very remarkable. The 2-month and 4-month local control effective rates （CR＋PR） were 47.8% （11/23） and 43.5% （10/23） respectively. During the follow-up period, no complications such as abdominal pain, pain in urination, radioactive enteritis, or bone marrow suppression, etc. occurred. Conclusion This preliminary study shows that brachytherapy of CT-guided percutaneous ^125I seed implantation is safe and effective for the treatment of pelvic and retroperitoneal malignant tumors. For the pelvic and retroperitoneal malignant tumors that are inoperable or postoperative recurrent, or that show poor response to pure radiotherapy and chemical therapy, this treatment is an effective and remedial therapeutic means, besides, it can effectively improve the quality of life of patients and improve the local control rate of tumor.
出处
《介入放射学杂志》
CSCD
北大核心
2016年第7期631-634,共4页
Journal of Interventional Radiology
