热疗联合^(125)I粒子治疗复发性直肠癌的近期疗效评价  

Observation on short-term efficacy of thermal-therapy combined with ^(125)I particles in treatment of recurrent rectal cancer

作　　者：王溪[1] 韩今华[1] 李云峰[1] 杨艳明[1] 

机构地区：[1]吉林大学第二医院放疗科,吉林长春130041

出　　处：《吉林大学学报（医学版）》2017年第5期963-966,共4页Journal of Jilin University：Medicine Edition

基　　金：国家自然科学基金青年基金资助课题(81502751)

摘　　要：目的:通过比较复发性直肠癌患者治疗前、后影像学和血清中癌胚抗原(CEA)以及术后随访结果,评价热疗联合^(125)I放射性粒子治疗直肠癌的有效性。方法:手术且放疗后行CT引导下^(125)I放射性粒子植入术(20例手术治疗患者,1例患者无法耐受热疗退出),术前应用放射性粒子治疗计划系统(TPS)制定粒子植入计划,粒子间距为1.0cm,植入后立即复查CT,再行剂量验证,植入粒子数量为12~58颗,每颗粒子放射性活度为0.5mCi,肿瘤周边匹配剂量为90~140Gy。射频热疗,每次60min,维持温度43℃,每周2次,连续3周。治疗后随访3个月,通过影像学结果和血清中CEA水平变化评价有效率,并评估尿频、尿痛、血尿和直肠出血等并发症。结果:与治疗前比较,随访6个月后影像学结果显示肿瘤缩小;患者治疗后血清中CEA水平由治疗前(30.25±8.32)mg·L^(-1)降低到(11.89±5.22)mg·L^(-1)(t=13.158,P<0.01);局部有效率94.7%(18/19),疼痛缓解率为94.4%(17/18);治疗前NRS评分中位数为6(4,7)分,治疗后NRS评分中位数为1(0,3)分,治疗前后比较差异有统计学意义(P<0.01)。随访期间患者未出现尿频、尿痛、血尿和直肠出血等并发症。结论:热疗联合^(125)I放射性粒子植入对复发性直肠癌具有较好的临床效果,是复发性直肠癌有效的综合治疗手段。Objective：To evaluate the clinical efficacy of thermal-therapy combined with ^125I radioactive particles by comparing the results of preoperative and postoperative images,serum carcino-embryonic antigen（CEA）and following-up after treatment of the patients with recurrent rectal cancer.Methods：Nineteen rectal cancer patients with postoperative recurrence after radiotherapy were treated with ^125I implantation guided by CT（20 cases were treated with operation,but 1 patient was exited who couldn＇t tolerate the thermal-therapy）.Radioactive particle treatment planning system（TPS）was used to make the plan before the particle implantation,and the distance of the particle was 1.0cm;all patients received CT scanning and were quantificationally evaluatated after implantation;the number of seeded particles was about 12-58,the radioactivity of the ^125I particle was 0.5mCi,and the matching dose surrounding the tumor was 90-140 Gy.All patients were treated with microwave thermal-therapy after particle implantation,60 min per time,lasting the temprature at 43℃,twice per week,for three weeks.And the patients were followed up after treatment for 3 months,the efficacy was evaluated by image and CEA results,and the urinary frequency,dysuria,hematuria and rectal bleeding were evaluated.Results：Compred with before treatment,after following up for 6months,the image results showed that the tumor volume was reduced,and the blood CEA level of all patients were decreased from（30.25±8.32）mg·L^-1 to（11.89±5.22）mg·L^-1（t=13.158,P〈0.01）;the local efficacy was 94.7%（18/19）,and the pain relief rate was 94.4%（17/18）;the NRS median was 6（4,7）before treatment,and it was 1（0,3）after treatment,there was significant difference（P〈0.001）.There were no frequent urination,urinary pain,hematuria,rectal bleeding and other complications in all patients.Conclusion：Thermal-therapy combined with ^125I radioactive particle implantation has good curative effects on the recurrent rectum cancer,and is

关 键 词：热疗 ^125I放射性粒子 直肠肿瘤 复发 

分 类 号：R735.37[医药卫生—肿瘤]