CT引导^125 I粒子植入治疗局部复发直肠癌疗效和剂量学分析  

Efficacy and dosimetry of computed tomography image-guided ^125 I radioactive seed implantation for locally recurrent rectal cancer

作　　者：王皓[1] 王俊杰[1] 袁慧书[2] 姜玉良[1] 田素青[1] 柳晨[2] 李金娜[1] 杨瑞杰[1] 孙海涛[1] 

机构地区：[1]北京大学第三医院肿瘤放疗科,100191 [2]北京大学第三医院放射科,100191

出　　处：《中华放射肿瘤学杂志》2016年第10期1096-1099,共4页Chinese Journal of Radiation Oncology

基　　金：国家自然科学基金青年基金（81402519）

摘　　要：目的：观察CT引导放射性^125 I粒子植入治疗局部复发直肠癌疗效，分析剂量学参数与预后间关系。方法回顾分析2003—2011年间本院CT引导下放射性^125 I粒子植入治疗的36例局部复发直肠癌资料。^125 I粒子植入术后即刻行CT扫描剂量验证，评估D90、D100、V100和V150。本组患者粒子活度中位数为0.7（0．4～0.8） mCi，植入粒子中位数为74（33～137）个。评价患者OS时间和LC时间及其与D90、D100、V100和V150的关系。 Kaplan-Meier计算LC率和OS率，Logrank单因素分析，Cox模型多因素分析。结果中位 OS 期为16.2（95％ CI为13．5～18.9）个月。中位 LC 时间为10.0（95％ CI为6．2～13.8）个月。 D90为（118．6±25.1） Gy，V100为（90．0±0.3）％。单因素分析提示D90与LC时间相关（ P＝0.048），V100与OS时间相关（ P＝0.035）。多因素分析显示V100＞90％是OS影响因素（ P＝0.044）。结论 CT引导放射性125 I粒子植入治疗局部复发直肠癌，术后验证计划D90＞140 Gy、V100＞90％有利于提高肿瘤LC率和OS率。术后验证计划D90和V100可能预测患者治疗疗效。Objective To evaluate the efficacy of computed tomography （ CT ） image-guided ^125 I radioactive seed implantation for locally recurrent rectal cancer （ LRRC ） , and to analyze the relationship between the dosimetry and prognosis. Methods A retrospective analysis was performed on the clinical data of 36 patients with LRRC who received CT image-guided ^125 I seed implantation in our hospital from 2003 to 2011. Dosimetric verification was performed using CT scan immediately after 125 I seed implantation. The D90 , D100 , V100 , and V150 values were evaluated. In all the patients, the median activity of seeds was 0.7 mCi （0.4-0.8 mCi） and the median number of implanted seeds was 74（33-137）. The local control （LC） and overall survival （ OS ） rates were calculated using the Kaplan.Meier method. The log-rank test and Cox regression model were used for the univariate and multivariate analyses, respectively. Results The median OS time was 16.2 months （ 95% CI= 13.5-18.9 months ） . The median LC time was 10.0 months （95% CI=6.2-13.8 months）. The D90 and V100 values were （118.6±25.1） Gy and （90.0±0.3）%, respectively. The univariate analysis suggested that D90 was correlated with the LC time （ P=0.048） and V100 was correlated with the OS time （ P=0.035） . The multivariate analysis showed that a V100 value higher than 90% was a prognostic factor of OS （P=0.044）. Conclusions In the treatment of LRRC using CT image-guided ^125 I radioactive seed implantation, a D90 value larger than 140 Gy and a V100 value higher than 90% in the postoperative verification plan help improve the LC and OS rates. The D90 and V100 values in the postoperative verification plan may predict treatment outcomes in patients.

关 键 词：肿瘤复发 直肠/放射性粒子植入 治疗结果 剂量学 

分 类 号：R735.37[医药卫生—肿瘤] R730.55[医药卫生—临床医学]