术中联合^125I粒子植入治疗中晚期食管鳞状细胞癌前瞻性研究  

Operation combined with ^125I radioactive seeds implantation therapy on advanced esophageal squamous cell carcinoma

作　　者：吕进[1] 曹秀峰[1] 朱斌[1] 纪律[1] 安红银[1] 

机构地区：[1]南京医科大学附属南京第一医院肿瘤中心外科,210006

出　　处：《中华外科杂志》2010年第5期338-341,共4页Chinese Journal of Surgery

摘　　要：目的探讨术中联合^125I粒子植入治疗胸段中晚期食管鳞状细胞癌（ESCC）的安全性及疗效。方法前瞻性队列研究，入组时间为2000年1月至2004年8月。298例Ⅱ～Ⅲ期胸段ESCC患者随机分为术中联合^125I粒子植入组（A组，150例）及单纯手术组（B组，148例）。A组术中直视下植入^125I粒子，术后通过CT和胸部X线片行粒子验证和质量评估。所有患者根据术中情况行食管癌根治术、姑息减瘤术或食管胃转流术。临床观察患者术后并发症，CT监测肿瘤影像学和局部复发情况，按WHO相关肿瘤评定标准评价患者近期疗效，随访术后1、3、5和7年生存率。结果随访截至2008年8月31日，中位随访42个月（95％CI：37～55个月）。A组术后粒子验证无移位、脱落，质量评估满意。A组及B组局部复发率分别为14．9％、38．7％，差异有统计学意义（P〈0．05）。术后3个月，A组有效率78．8％，与B组30．3％比较差异有统计学意义（P〈0．05）。两组并发症差异无统计学意义（P〉0．05）。A组及B组的3、5和7年生存率分别为64．0％比52．0％、42．7％比34．5％、25．1％比12．6％，差异有统计学意义（P〈0．05）。结论术中联合^125I粒子植入治疗中晚期ESCC是简单、安全、有效的方法，可降低局部复发率、延长患者生存期。Objective To evaluate the safety and efficacy of the united intraoperative ^125I seed implantation as a treatment option for thoracic advanced esophageal squamous cell carcinoma （ESCC）. Methods From January 2000 to August 2004, according to preoperative CT staging criteria ,298 patients in phase II to III of ESCC had been enrolled in this prospective study. With informed consent, they were randomized into two groups： intraoperative ^125I seed implantation （group A） and surgery alone （group B）. With 0. 5 mCi of single seed, total activity in 10 to 30 mCi, matched peripheral dose in 60 to 70 Gy, 20 to 40 ^125I seeds were implanted into the target under direct vision in accordance with treatment planning system. The post-operative complications were observed. The validation and quality assessment of radioactive seeds were demonstrated according to CT scan or X imaging. The short-term efficacy was evaluated according to WHO criteria. The 1-, 3-, 5-, and 7-year survival rate were followed up. Results On the close date of August 31 st 2008, the satisfied quality assessment of ^125I seeds was observed. There was no displacement or loss of seed. The local recurrence rates in the group A and group B were 14. 9% and 38. 7% , respectively, which were statistically significant （ P 〈 0. 05 ）. The complete response and partial response rate in the group A was 78. 8%. It was significantly higher than 30. 3% in the group B （P 〈0. 05）. There was no statistical difference among groups when comparing the complications （ P 〉 0. 05 ）. The 1-year survival rates were no statistical difference among the two groups. However, the 3-, 5-, and 7-year survival rates in group A （64. 0% , 42. 7% , and 25.1% ） were statistically different from that in the B group （52. 0% , 34. 5% , and 12. 6% ） （P 〈 0. 05 ）. Conclusions It is safe, effective and simple application about the intraoperative ^125I seed implantation for advanced ESCC. It may reduce the local recurrence rate and improve survival.

关 键 词：食管肿瘤 近距离放射疗法 碘放射性同位素 

分 类 号：R735.9[医药卫生—肿瘤]