超声内镜引导下碘125粒子植入联合化疗治疗腹腔实体肿瘤的前瞻性研究  

Endoscopic ultrasonography-guided interstitial implantation of iodine 125 seeds combined with chemotherapy in the treatment of unresectable abdominal carcinoma： a prospective study

作　　者：金震东[1] 李兆申[1] 杜奕奇[1] 江月萍[2] 陈洁[1] 刘岩[1] 湛先保[1] 

机构地区：[1]第二军医大学长海医院消化内科,200433 [2]青岛大学医学院附属医院消化科

出　　处：《中华消化内镜杂志》2007年第1期23-28,共6页Chinese Journal of Digestive Endoscopy

基　　金：上海市自然科学基金资助项目（062R14113）

摘　　要：目的评价内镜超声检查术（EUS）引导下肿瘤内植入放射性碘125（^125I）粒子联合化疗治疗胰腺癌的疗效和安全性，并探讨该方法用于其他腹腔原发或继发实体肿瘤治疗的可行性。方法对28例不能手术切除的腹腔实体肿瘤患者进行了EUS引导^125I粒子植入内照射治疗，术后1周内采用吉西他滨＋氟脲嘧啶化疗方案。包括中晚期胰腺癌25例（胰头癌8例、胰体尾癌17例），胆管癌腹膜后转移、腹膜后腺癌和贲门癌术后腹腔转移各1例。所有病例术前均参照TPS系统估算期望植入粒子数量，比较术前及术后不同时期的肿瘤直径、生活质量评分以及疼痛VAS评分等项目。结果28例患者均经EUS成功植入^125I粒子，平均每次植入粒子数量的中位数为10颗（5～20颗），最多1例胰腺癌分3次共植入30颗粒子，平均单颗粒子的放射性活度为26．2MBq。术后平均随访4．8个月（0．3—14个月），Kaplan-Meier法评估的中位生存期为9．4个月（95％CI6．5～11．6个月）。术后1个月评估疗效，达到部分缓解3例（10．7％），疾病稳定12例（42．9％），进展恶化10例（35．7％，其中8例死亡），3例失访。粒子植入1周后疼痛VAS评分由5．07±2．63下降至1．73±1．91（P〈0．01），1个月后仍低于术前评分（3．53±1．51，P〈0．05）。有52．9％的患者于术后24h内出现发热，无其他并发症出现。结论EUS引导下^125I粒子组织间植入是治疗包括胰腺癌在内的腹腔实体肿瘤的新型介入技术，可明显延缓肿瘤进展，具有稳定的止痛疗效，安全性高，值得进一步探讨其临床应用价值。Objective To introduce the procedures and evaluate endoscopic ultrasonography-guided interstitial implantation of radioactive iodine 125 seeds in the treatment of pancreatic cancer as well as other abdominal malignancies. Methods Totally 25 cases of pancreatic cancer and three metastases （ a cholangiocarcinoma, a carcinoma of gastric cardia and an unknown secondary adenocarcinoma） underwent endoscopic ultrasonography-guided interstitial iodine seeds implantation. Expected number of seeds was calculated with CT-based TPS system. The tumor size, Quality of Life （QoL） and VAS pain score before and after brachytherapy were assessed as the treat effect. Results All 28 patients were implanted ^125I seeds successfully under EUS, with a median amount of 10 （ range from 5 to 20） every time and maximum of 30. The mean activity per seed was 26. 2 MBq. Mean follow-up time was 4. 8 months （ range from 0. 3 to 14 months ） and the estimated median survival time was 9.4 months by Kaplan-Meier method. Eight patients died during followup and twelve patients got stable disease. VAS score dropped from 5.07 ± 2. 63 to 1.73 ± 1.91 （ P 〈 0. 01 ） within one week after brachytherapy and remained as 3.53 ± 1.51 （P 〈0. 05） one month later. No obvious complications were observed after therapy, except for slight fever within 24 hours. Conclusion Endoscopic ultrasonography-guided interstitial implantation of iodine 125 seeds is a novel treatment towards abdominal carcinoma including pancreatic cancer. Over half of patients can benefit from the therapy. Noticeably, it shows better effect on pain relief with lower incidence of complication.

关 键 词：肿瘤 胰腺 内窥镜超声检查术 靶点放射疗法 药物疗法 辅助 碘125粒子 

分 类 号：R735[医药卫生—肿瘤] R44[医药卫生—临床医学]