CT引导下^(125)Ⅰ粒子植入治疗腹部淋巴结转移癌的临床应用  

CT-guided ^(125)Ⅰ seed brachytherapy for abdominal metastatic lymph nodes

作　　者：汪建华[1,2] 左长京[3] 邵成伟[1] 马小龙[1] 张建[3] 田建明[1] 

机构地区：[1]上海第二军医大学附属长海医院放射科,200433 [2]浙江省宁波市第二医院放射科 [3]上海第二军医大学附属长海医院核医学科,200433

出　　处：《介入放射学杂志》2011年第11期877-881,共5页Journal of Interventional Radiology

基　　金：国家自然科学基金资助项目(30970801)

摘　　要：目的探讨CT引导下125Ⅰ粒子植入术治疗腹部恶性肿瘤的腹腔及腹膜后区转移性淋巴结的安全性及疗效。方法回顾性分析27例经病理确诊的腹部恶性肿瘤患者共31枚腹腔及腹膜后区转移性淋巴结(直径2.2～4.7 cm)接受经CT引导下125Ⅰ放射性粒子植入治疗的临床资料。植入量遵循Halarism 125Ⅰ经验公式确定,粒子活度为0.5～0.85 mCi,以间距1.0～1.5 cm布源。植入完毕后即行CT扫描,了解粒子分布情况及有无并发症。植入术后3个月行CT或PET-CT复查,参考WHO实体肿瘤评价标准进行影像学疗效评估。结果 27例中,25例手术一次植入成功,达到剂量要求,粒子分布满意率92.6%(25/27例),2例首次术后未达到要求而补种粒子。术前8例伴有明显疼痛患者中,6例于术后1～3周疼痛缓解。术后随访3个月,27例患者均生存。27例患者中淋巴结完全缓解12例,部分缓解8例,稳定4例,进展3例,总有效率74.1%(20//27)。本组术中及术后未发现剧烈疼痛、大出血、感染、骨髓抑制等严重并发症。结论 CT导向下组织间植入放射性125Ⅰ粒子是治疗腹部转移性淋巴结具有近期疗效好、创伤小、并发症少等优点。Objective To investigate the safety and clinical efficacy of CT-guided radioactive seed 125Ⅰ implantation in treating abdominal and retroperitoneal metastatic lymph nodes.Methods Twenty-seven patients with pathologically proved abdominal malignancy（17 males and 10 females） were enrolled in this study.The primary tumors included liver cancer（n = 13）,pancreatic cancer（n = 8） and gastric cancer（n = 6）.A total of 31 abdominal and peritoneal metastatic lymph nodes（diameter of 2.2-4.7 cm） were detected and CT-guided radioactive seed 125Ⅰ implantation was carried out.Halarism 125Ⅰ experience formula was used to design the distribution of seed 125Ⅰ.Under CT guidance,125Ⅰ seeds were implanted into the metastatic lymph nodes at a distance interval of 1.0-1.5 cm.After implantation,CT scanning was immediately performed to check the distribution of 125Ⅰ seeds and to observe the possible complications.CT or PET-CT re-examination was performed at 3 months after 125Ⅰ seed implantation.Results Of the 27 patients,125Ⅰ seed implantation was successfully accomplished in 25（92.6%） at the first time and the particle distribution met the radioactive requirements well.In the remaining 2 patients the particle distribution did not meet the requirements and replacement of 125Ⅰ seed had to be made.In this group,8 patients had severe pain before treatment and in six of them the pain was markedly relieved at 1-3 weeks after seed 125Ⅰ implantation,with a response rate of 75.0%.The patients were followed up for three months and all the 27 patients survived.According to the results of CT or PET-CT re-examination,12 of 27 patients（44.4%） achieved complete remission（CR）,8（29.6%） achieved partial remission（PR）,4（14.8%） showed no change（NC） and 3（11.1%） had progressive disease（PD）.The overall response rate was 74.1%（20/27）.No severe complications,such as acute pain,massive bleeding,infection and bone marrow suppression,occurred.Conclusion For the treatment of abdominal a

关 键 词：肿瘤 肿瘤转移 淋巴结 腹部 体层摄影术 X线计算机 近距离放射疗法 碘放射性核素 

分 类 号：R735[医药卫生—肿瘤]