CT引导下^(125)I粒子植入治疗Ⅲ期非小细胞肺癌疗效与并发症的临床观察  

CT-guided percutaneous ^(125)I seed implantation brachytherapy in patients with stage Ⅲ non-small-cell lung cancer

作　　者：戴建建[1] 袁冰[1] 张颖[1] 林琦[1] 袁苑[1] 韩明勇[1] DAI Jianjian YUAN Bing ZHANG Ying LIN Qi YUAN Yuan HAN Mingyong(Department of Health Oncology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250014, Shandong, China)

机构地区：[1]山东大学附属省立医院东院保健综合(肿瘤)科,山东济南250014

出　　处：《山东大学学报（医学版）》2017年第2期32-37,共6页Journal of Shandong University:Health Sciences

基　　金：国家自然科学基金(81272351)

摘　　要：目的观察CT引导下^(125)I粒子植入治疗在Ⅲ期非小细胞肺癌患者中的疗效及并发症。方法回顾性分析19例行CT引导下^(125)I粒子植入治疗的Ⅲ期原发性非小细胞肺癌患者的临床资料。术前行胸部增强CT扫描,明确肿瘤部位、大小、与周围脏器毗邻关系,血液学检查排除凝血及肝肾功能异常。术前依据肿瘤CT影像,采用治疗计划系统(TPS)制定治疗计划,处方剂量(PD)为120 Gy。于CT引导下行经皮^(125)I粒子植入治疗。手术均在局部麻醉下进行。术后1、3、6个月行胸部增强CT扫描随访。根据实体肿瘤疗效评价标准评估疗效。结果 19例患者的中位肿瘤体积为20 cm3。术后1个月局部控制率(CR+PR+SD)为94.7%(18/19),术后2个月局部控制率为94.7%(18/19),术后5个月局部控制率为87.5%(14/16),术后7个月局部控制率为83.3%(10/12),术后8、9个月局部控制率分别为85.7%、83.3%。中位随访时间7个月(4~24个月),中位局部进展时间7个月(2~21个月)。所有患者均无近期严重并发症出现,轻度并发症包括肺内出血7例,皮下血肿1例,轻度气胸1例、中大量气胸行胸腔闭式引流5例,迟发性气胸1例,咯血3例,皮下气肿1例。结论 CT引导下经皮^(125)I粒子植入治疗Ⅲ期非小细胞肺癌的局部控制效果较好,与操作相关的并发症较少,操作相对安全,可作为不能手术的非小细胞肺癌的一种辅助治疗手段。Objective To assess the efficacy and complications of CT-guided percutaneous^（125）I seed implantation brachytherapy in the treatment of stage Ⅲ non-small-cell lung cancer（ NSCLC）. Methods Clinical date of 19 stageⅢ NSCLC cases were retrospectively analyzed. All cases were pathologically confirmed. The median age of patients was 57 years. Preoperative chest enhanced CT scan was performed to showthe location and size of the tumor and its relation with surrounding organs. Hematologic studies were conducted to exclude patients with coagulant or hepatic and renal function abnormality. The treatment planning system（ TPS） was used preoperatively to calculate the estimated seed number and distribution. The prescription dose（ PD） was 120 Gy.^（125）I seeds were implanted percutaneously under CT guidance and local anesthesia. Follow-up CT scan was performed 1,3 and 6 months after surgery. Therapeutic effect was evaluated according to response evaluation criteria in solid tumors（ RECIST）. Results The median volume of tumors was 20 cm3. Local tumor control rate（ CR ＋ PR ＋ SD） was 94. 7%（ 18 /19）,94. 7%（ 18 /19）,87. 5%（ 14 /16）,83. 3%（ 10 /12）,85. 7%（ 6 /7） and 83. 3%（ 5 /6） 1,2,5,7,8 and 9 months after operation. The median follow-up was 7 months（ 4-24）,and the median time to progression was 7 months（ 2-21）. No major complications were observed. Minor complications included pulmonary hemorrhage（ n = 7,37%）,subcutaneous hematoma（ n = 1,5%）,mild pneumothorax（ n = 1,5%）,closed drainage of thoracic cavity（ n = 5,26%）,late-onset pneumothorax（ n = 1,5%）,hemoptysis（ n = 3,16%）,and subcutaneous emphysema（ n = 1,5%）. Conclusion Safe and effective,CT-guided percutaneous^（125）I seed implantation brachytherapy can serve as an adjuvant option in the treatment of stage Ⅲ NSCLC.

关 键 词：125I粒子 近距离照射治疗 非小细胞肺癌 计算机断层扫描 

分 类 号：R730.55[医药卫生—肿瘤]