125I粒子植入治疗难治性甲状腺癌骨转移临床应用  

Clinical application of 125I seeds implantation for bone metastasis from iodine-refractory differentiated thyroid cancer

作　　者：陈志军[1] 谭丽玲[2] 粟宇 谢建国[1] 周爱清[1] 邹弯弯 王文俊[1] 许波 徐璐 

机构地区：[1]江西省肿瘤医院核医学科,南昌330029 [2]南昌大学第二附属医院核医学科,330006

出　　处：《中华核医学与分子影像杂志》2018年第1期14-16,共3页Chinese Journal of Nuclear Medicine and Molecular Imaging

摘　　要：目的探讨125I粒子植入治疗难治性分化型甲状腺癌（RAIR－DTC）骨转移的临床效果。方法前瞻性选取2014年4月至2016年12月间9例RAIR－DTC骨转移患者（男4例、女5例，年龄42～87岁）。经放射治疗计划系统（TPS）制定治疗计划，CT引导下行125I粒子植入，治疗后2、4个月随访转移灶大小、血清甲状腺球蛋白（Tg）、语言分级评分（VRS）法疼痛评分变化。采用配对t检验和两样本t检验分析数据。结果125I粒子植入治疗后2个月VRS疼痛评分较治疗前下降（2.56±0.88和5.22±2.44；t＝4.28, P〈0.01）;治疗后4个月的VRS疼痛评分为1.78±0.83，较治疗后2个月下降（t＝3.48, P〈0.01）。125I粒子植入治疗后2个月肿瘤最大径较治疗前缩小[（5.08±2.11）和（6.47±1.84） cm；t＝9.14, P〈0.01];治疗后4个月的肿瘤最大径为（4.52±2.16） cm，虽较治疗后2个月有所缩小，但差异无统计学意义（t＝2.19, P〉0.05）。125I粒子植入治疗后2个月血清Tg（lgTg）较治疗前下降（2.71±0.85和2.94±0.82；t＝4.82, P〈0.01）;治疗后4个月的血清Tg（lgTg）为2.56±0.81，较治疗后2个月下降（t＝2.69, P〈0.05）。结论125I粒子植入是治疗RAIR－DTC骨转移患者的有效方法，可缩小骨转移癌病灶、减轻患者疼痛、提高患者生存质量。ObjectiveTo investigate the clinical effect of 125I seeds implantation on bone metastasis from radioactive iodine-refractory differentiated thyroid carcinoma （RAIR-DTC）.MethodsA total of 9 RAIR-DTC patients with bone metastases （4 males, 5 females, age range： 42-87 years） between April 2014 and December 2016 were enrolled in this prospective study. Treatment plan was developed through treatment planning system （TPS）. 125I seeds implantation was performed under CT guidance. After 2 and 4 months, metastasis size, serum thyroglobulin （Tg） and verbal rating scale （VRS） pain score changes were recorded. Paired t test and two-sample t test were used for data analysis.ResultsVRS pain score decreased 2 months post-treatment comparing with that before treatment （2.56±0.88 vs 5.22±2.44; t=4.28, P〈0.01）. VRS pain score at 4 months post-treatment was 1.78±0.83, which was lower than that at 2 months post-treatment （t=3.48, P〈0.01）. The maximum tumor diameters before the implantation and 2 months post-treatment were （6.47±1.84） cm and （5.08±2.11） cm, respectively （t=9.14, P〈0.01）. The maximum tumor diameter at 4 months post-treatment showed a decreasing trend but it was not statistically different compared to that at 2 months post-treatment： （（4.52±2.16） cm; t=2.19, P〉0.05）. Serum Tg level reduced 2 months after the implantation （lgTg： 2.71±0.85 vs 2.94±0.82; t=4.82, P〈0.01）. Serum Tg level at 4 months post-treatment （lgTg： 2.56±0.81） was lower than that at 2 months post-treatment （t=2.69, P〈0.05）.Conclusions125I seeds implantation is an effective method for treating bone metastasis from RAIR-DTC. It can help to shrink bone metastasis, alleviate pain and improve patients′ quality of life.

关 键 词：甲状腺肿瘤 肿瘤转移 骨骼 近距离放射疗法 碘放射性同位素 

分 类 号：R730.55[医药卫生—肿瘤] R736.1[医药卫生—临床医学]