放射性^(125)I粒子治疗食管鳞癌的安全性及疗效  

^(125)I seed implantation brachytherapy for esophageal squamous cell carcinoma

作　　者：吕进[1] 曹秀峰[1] 朱斌[1] 纪律[1] 肖建[2] 王冬冬[1] 陶磊[1] 王山 安红银 

机构地区：[1]南京医科大学附属南京第一医院肿瘤外科,江苏省南京市210006 [2]复旦大学附属中山医院青浦分院,上海市201700 [3]盐城市肿瘤医院胸外科,江苏省盐城市224002

出　　处：《世界华人消化杂志》2010年第29期3065-3071,共7页World Chinese Journal of Digestology

摘　　要：目的:探讨125I粒子在体内外对人ESCC的疗效和作用机制以及植入治疗胸段中晚期食管鳞癌(ESCC)的安全性及疗效.方法:细胞及动物实验:125I粒子植入体外培养的人食管鳞癌Eca-109细胞,分A组不加粒子(对照组);B组0.2mCi(低剂量组);C组0.4mCi(中剂量组);D组0.8mCi(高剂量组).分析细胞克隆形成率、细胞凋亡指数和细胞周期分布情况;建立裸鼠皮下移植性食管癌模型后,对照组(A组,不做任何处理)、假手术组(B组,穿刺瘤体1次,但不植入粒子)、低剂量组(C组,0.2mCi)、中剂量组(D组,0.4mCi)和高剂量组(E组,0.8mCi),计算各组抑瘤率.临床试验:前瞻性研究,入组时间为2000-2004年.根据ESCC术前CT分期标准,298例Ⅱ-Ⅲ期胸段ESCC患者随机分为术中联合125I粒子植入组及单纯手术组.依据TPS所确定的剂量,A组术中直视下植入125I粒子.选用0.5mCi的125I粒子20-40粒,总活度在10-30mCi,肿瘤匹配周边剂量60-70Gy,术后行粒子验证和质量评估.观察患者术后并发症、监测局部复发情况、评价患者疗效.结果:细胞克隆形成率B、C、D组均低于A组(P<0.05);C、D组均低于B组(P<0.01);C、D组无统计学差别(P>0.05).细胞凋亡指数B、C、D组均高于A组(P<0.01);C、D组均高于B组(P<0.01),C、D组无统计学差别(P>0.05).随粒子剂量增加,G2/M期细胞所占比例增高,各组之间均有统计学意义(P<0.01).动物实验中,瘤体积C、D、E组明显小于A组(P<0.05),D、E组均小于C组(P<0.05),但D、E组之间无统计学意义(P>0.05);B、A组瘤体积相比无统计学意义(P>0.05).临床试验中,术中联合125I粒子植入组术后粒子验证无移位、脱落,质量评估满意.术中联合125I粒子植入组与单纯手术组局部复发率分别为14.9%、38.7%,差异有统计学意义(P<0.05).术中联合125I粒子植入组术后3mo有效率(CR+PR)高于单纯手术组,差异有统计学意义(78.8%vs30.3%,P<0.05).二组并发症比较无统计学意义(P>0.05).术中联合125I粒子�AIM：To evaluate the safety and efficacy of intraoperative ^125I seed implantation for advanced esophageal squamous cell carcinoma（ESCC）.METHODS：Eca-109 cells cultured in vitro were divided into four groups：cells untreated（control group） and those treated with low-（0.2 mCi）,medium-（0.4 mCi） and high-dose ^125I seeds（0.8 mCi）.After ^125I seed implantation,the cloning efficiency,apoptotic index and cell cycle of Eca-109 cells were detected.For animal experiment,Eca-109 cells were inoculated subcutaneously in the right femoribus internus of nude mice.ESCC-bearing mice were then divided into five groups：mice untreated（control group）,mice undergoing spurious operation（prick into the tumor without implanting seeds）,and those treated with low-（0.2 mCi）,medium-（0.4 mCi） and high-dose ^125I seeds（0.8 mCi）.Tumor volume was then evaluated.For clinical trial,298 patients with phase II to III ESCC were randomized into two groups：patients undergoing both surgery and intraoperative 125I seed implantation and those undergoing surgery alone.Postoperative complications were observed.The shortand long-term efficacy of ^125I seed implantation was followed up.RESULTS：The cloning efficiency of cells of the three treatment groups was significantly lower than that of control cells（all P〈0.05）.The cell cloning efficiency was also significantly lower in cells treated with high-and medium-dose 125I seeds than in those treated with low-dose ^125I seeds（both P 〈0.01） though no significant difference was noted between the high-and medium-dose groups（P〉0.05）.The apoptotic index（AI） of cells of the three treatment groups was significantly higher than that of control cells（all P 〈0.01）.The apoptotic index（AI） was also significantly higher in cells treated with highand medium-dose ^125I seeds than in those treated with low-dose ^125I seeds（both P〈0.01） though no significant difference was noted between the high-and medium-dose groups（P〉0.05）.The percent

关 键 词：食管鳞癌 近距离放射疗法 125I粒子 胸外科 

分 类 号：R735.1[医药卫生—肿瘤]