CT引导下^125I放射性粒子组织间植入治疗复发性卵巢癌  

Interstitial implantation of ^125I seed therapy for recurrent ovarian cancer

作　　者：李常仑[1] 刘继红[2] 黄金华[1] 顾仰葵[1] 高飞[1] 黄绮丹[2] 胡莹莹[3] 江雄鹰[1] 黄英杰[1] 

机构地区：[1]华南肿瘤学国家重点实验室中山大学肿瘤医院影像与微创介入中心,广州510060 [2]华南肿瘤学国家重点实验室中山大学肿瘤医院妇科,广州510060 [3]华南肿瘤学国家重点实验室中山大学肿瘤医院核医学科,广州510060

出　　处：《中华医学杂志》2012年第39期2760-2763,共4页National Medical Journal of China

摘　　要：目的探讨CT引导下放射性^125碘（I）放射性粒子组织间植入对复发性卵巢癌治疗的可行性、近期疗效及并发症。方法2009年10月至2010年11月，收集中山大学肿瘤医院影像与微创介入中心^18F-FDGPET／CT诊断的12例复发卵巢癌患者共25处病灶，其中21处病灶采用放射性粒子组织间植入治疗，1例患者3处肝、1处脾转移病灶采用CT引导下微波消融治疗。9例患者粒子植入术后进行了2～6疗程化疗。在采用粒子植入治疗的21处病灶中长径〉2cm的11处，≤2CM的10处；根据PET／CT图像显示的病灶高代谢范围，应用放射性粒子治疗计划系统（TPS）或Memorial Sloan—Ketterin列解图法（nomogram）制定粒子植入计划；靶区匹配周边剂量（MPD）为145Gy，植入粒子数9—45颗，中位数20．5颗。应用^18F—FDG PET／CT或CT判断放射性粒子治疗效果。结果术后随访时间9—19个月，中位随访时间15个月，除1例患者因肿瘤侵犯双侧输尿管引起肾功能衰竭导致死亡外，其余患者随访期内均存活。在21处粒子植入治疗的病灶中，10处肿瘤病灶完全缓解（CR），6处部分缓解（PR），5处局部进展（PD），有效率76．2％。经Fisher确切概率法统计分析，长径≤2cm病灶局部控制效果好于长径〉2cm的病灶（P=0．035）。微波消融治疗肝、脾共4处病灶，经^18F—FDG PET／CT检查肿瘤活性完全消失。1例患者术中穿刺时损伤坐骨神经，出现了右下肢麻木、疼痛，半年后症状逐渐消失；本组患者未出现肠瘘、直肠炎等放射性损伤并发症。结论CT引导下^125I放射性粒子组织间植入可用于复发性卵巢癌治疗，其近期疗效好、并发症少。^125I粒子植入治疗与化疗结合，具有巩固和提高局部复发性卵巢癌的疗效作用。Objective To explore the feasibility, short-term efficacies and complications of computed tomography （CT）-guided ^125I interstitial implant therapy for recurrent ovarian cancer. Methods From October 2009 to November 2010, a total of 25 lesions for 12 patients were diagnosed as recurrent ovarian cancer by positron emission tomography/computed tomography （PET/CT）. Among 25 lesions, 21 underwent ^125I seed implantation. And 4 lesions of liver and spleen in one patient were treated with microwave ablation. Nine patients underwent 2 - 6 cycles of chemotherapy after seeding. There were 11 lesions with diameter 〉 2 cm and 10 ≤2 cm. According to the area of physiologic ^18FDG uptake in lesions, the treatment plans were formulated by computerized treatment planning system （TPS） and Memorial Sloan-Ketterin nomograph. The matched peripheral dose （MPD） was 145 Gy in target mass. A median of 20. 5 seeds per patient （range： 9 -45） were implanted. The efficacies were evaluated by CT and ^18F-FDG PET/CT findings. Results One patient died of renal failure while the other patients survived during a median follow- up of 15 mouths （range： 9 -19）. Ten lesions showed complete remission, 6 partial remission and 5 progressive disease. The effective rate was 76. 2% （ 16/21 ）. Compared with those 〉 2 cm, the lesions ≤ 2 cm in diameter had a better local control rate by Fisher＇s exact test （P = 0. 035 ）. The hepatic and renal lesions treated by microwave ablation showed inactivation on PET/CT. Only one patient suffered from sciatic： nerve injury caused by punctuation and numbness and pain of right lower extremity were persistent. There was no onset of Ihe complications of radiation injury, such as intestinal fistula and proctitis. Conclusion The CT-guided ^125I interstitial implant therapy for recurrent ovarian cancer yields excellent short-term efficacies with fewer complications. The combined modality of ^125I interstitial implant and chemotherapy may further improve the patient outcomes.

关 键 词：卵巢肿瘤 正电子发射断层显像术 放射性同位素 

分 类 号：R737.31[医药卫生—肿瘤]