^(125)I粒子植入治疗宫颈癌放疗后复发腹膜后淋巴结转移10例  

^(125)I seed implantation for retroperitoneal lymph node metastasis caused by recurrent cervical cancer after radiotherapy:preliminary results

作　　者：底学敏 王泽阳[2] 任红[2] 杨圣俊[2] 赵宪芝 于慧敏[2] 张宏涛[2] 王娟[2] DI Xuemin WANG Zeyang REN Hong YANG Shengjun ZHAO Xianzhi YU Huimin ZHANG Hongtao WANG Juan(Division I, Department of Oncology, Hebei Provincial People＇s Hospital, Shijiazhuang, Hebei Province 050051, China)

机构地区：[1]河北医科大学研究生学院,石家庄050051 [2]河北省人民医院肿瘤一科

出　　处：《介入放射学杂志》2017年第2期137-141,共5页Journal of Interventional Radiology

基　　金：河北省医学适用技术跟踪项目(GL201407)

摘　　要：目的探讨CT引导下放射性^(125)I粒子植入治疗宫颈癌放疗后复发腹膜后淋巴结转移初步疗效。方法选取2011年11月至2015年10月宫颈癌放疗后复发腹膜后淋巴结转移10例患者,12个病灶,垂直径1.7 cm×1.0 cm^6.5 cm×5.0 cm,其中直径<5.0 cm、≥5.0 cm的淋巴结分别为6个(50%)、6个(50%)。应用近距离治疗计划系统(TPS)制定治疗计划,CT引导下植入^(125)I粒子,活度0.3~0.7 m Ci,术后验证D90(90%靶体积所接受的最小剂量):36~110 Gy(中位59 Gy)。术后观察病灶大小变化、疼痛缓解情况及并发症。结果 10例患者随访时间4.3~16.1个月,中位随访时间9.7个月,2个月局部控制率100%、有效率58.3%,2、6、12个月生存率分别为100%、66.7%、58.3%,中位生存时间12.1个月。1例患者术后5个月死于消化道出血,6例死于肿瘤转移,3例患者生存并未见粒子植入部位复发,未见其他部位大出血、肠道感染、骨髓抑制等粒子相关严重并发症。结论 CT引导下^(125)I粒子植入治疗宫颈癌放疗后复发腹膜后淋巴结转移取得了较满意的近期疗效,是一种安全可行的方法。Objective To evaluate the safety and efficacy of CT-guided radioactive 125I seed implantation in treating retroperitoneal lymph node metastasis due to recurrent cervical cancer after radiotherapy. Methods A total of 10 patients with retroperitoneal lymph node metastasis （12 lesions in total）due to recurrent cervical cancer after radiotherapy, who were treated with CT-guided 125I seed implantation during the periodfrom November 2011 to October 2015, were included in this study. The diameters, that were perpendicular to each other, of the involved lymph nodesranged from 1.7 cmxl cm to 6.5 cm×5 cm, the diameter of 6 involved lymph nodes （50%） was 〈5.0 cm and the diameter of other 6 involved lymph nodes （50%） was ≥5.0 cm. With the help of treatment planning system for brachytherapy, the source distribution was formulated. Under CT guidance, the 125I seedswith the activity of 0.3-0.7 mCi were implanted. Postoperative validation showed that Dgo （90% minimum prescription dose received by the target volume） was 36-110 Gy （median 59 Gy）. After the treatment, the changes in lesion size, pain relief and complications were recorded. Results The 10 patients were followed up for 4.3-16.1 months, tile median follow-up time was 9.7 months. The 2-month local control rate and the 2-month effective rate were 100% and 58.3%, respectively. The 2-month, 6-month and 12-month survival rates were 100%, 66.7% and 58.3%,respectively. The median survival time was 12.1 months. One patient （10%） died of gastrointestinal bleeding at five months after treatment, six patients （60%） died of distant metastases, three patients （30%） survived withno evidence of local recurrence. No major complications such as massive hemorrhage, intestinal infection, bone marrow suppression or other 125I seed- related complications occurred. Conclusion For the treatment of retroperitoneal lymph node metastasis due to recurrent cervical cancer after radiotherapy, CT-guided radioactive lzsI seed implantation has satisfactory short-

关 键 词：宫颈癌 近距离放射治疗 腹膜后淋巴结转移 疗效 

分 类 号：R737.33[医药卫生—肿瘤]