肝细胞肝癌125I粒子植入影响肿瘤局部控制临床研究  

The influences of 125I seed implantation on tumor local control in hepatocellular carcinoma: a clinical study

作　　者：张国正 郑家平[2] 邵国良[2] 罗君[2] 文颂[2] 季永领[3] 徐敏[2] 郭立文[2] 陈莉萍[2] 俞炎平[2] 尚岩 ZHANG Guozheng;ZHENG Jiaping;SHAO Guoliang;LUO Jun;WEN Song;JI Yongling;XU Min;GUO Liwen;CHEN Liping;YU Yanping;SHANG Yan(Second Clinical Collage, Zhejiang University of Traditional Chinese Medicine, Hangzhou, Zhejiang Province 310000, China)

机构地区：[1]杭州浙江中医药大学第二临床医学院 [2]浙江省肿瘤医院介入治疗科 [3]浙江省肿瘤医院放疗科 [4]浙江省衢州市柯城区人民医院 [5]台州市肿瘤医院介入科

出　　处：《介入放射学杂志》2019年第7期656-660,共5页Journal of Interventional Radiology

基　　金：浙江省医药卫生一般研究计划项目(2016KYA043、2013KYB041、2012KYB026);温岭市科技计划项目(2017C31BG0006);浙江省卫生高层次创新人才培养工程基金(2012-241)

摘　　要：目的研究肝细胞肝癌(HCC)行 125I 放射性粒子植入补救治疗后影响肿瘤局部控制(DCR)的关键因素。方法共纳入 HCC 患者 68 例,接受 CT 引导下 125I 放射性粒子组织间植入治疗,粒子活度选择 0.6~0.8 mCi,匹配周围剂量(处方剂量,MPD)设置 110~160 Gy,近期疗效评估采用 mRECIST 标准,对影响肿瘤 DCR 的诸多因素,如性别、年龄、肿瘤大小、粒子数量、粒子分布模式(分巴黎布源模式和蒙特卡洛布源模式两种),以及粒子植入术后即刻 D90 剂量等 6 个因素采用非参数二分类 logistic 多因素分析。结果 68 例 HCC 患者均成功完成 125I 放射性粒子植入补救治疗。未发生三级以上不良事件。 65 例患者获得随访和评估。单因素分析显示,病灶大小(P=0.006)和 D90 剂量(P<0.001)对 DCR 有影响,肿瘤最大径>5 cm,D90<110 Gy 预示 DCR 未控;多因素分析显示,D90 剂量(P<0.001)是唯一影响 DCR的关键参数。结论对于 125I 放射性粒子植入补救治疗 HCC 而言,D90 剂量是唯一影响肿瘤 DCR 的关键因素,足量的周边匹配剂量才能保证良好的临床疗效。Objective To investigate the key factors affecting disease control rate (DCR) of hepatocellular carcinoma (HCC) after remedial treatment of 125I seed implantation. Methods A total of 68 patients with HCC were enrolled in this study. All patients received CT - guided 125I seeds interstitial implantation. The activity of 125I seed was 0.6-0.8 mCi, the matched peripheral dose (MPD) was 110-160 Gy. The mRECIST criterion was used to evaluate the short-term curative effect. The factors affecting tumor DCR, including gender, age, tumor size, number of 125I seeds, 125I distribution pattern (Paris source model and Monte Carlo source model), and immediate 90% target volume absorbed dose (D90) after 125I seeds implantation, were statistically analyzed with non - parametric binary logistic multivariate analysis method. Results Successful remedial treatment of 125I seed implantation was accomplished in all 68 HCC patients. No grade Ⅲ or above adverse reactions occurred. A total of 65 patients were able to be followed up and evaluated. Univariate analysis showed that the lesion size (P=0.006) and D90 dose (P<0.001) had an effect on DCR. The maximum diameter of tumor >5 cm and D90<110 Gy indicated that an uncontrolled DCR might be expected. Multivariate analysis revealed that D90 dose (P<0.001) was the only key parameter affecting DCR. Conclusion For the remedial treatment of HCC with 125I seed implantation, D90 dose is the only key factor that affects DCR. Adequate MPD should be given in order to ensure a good clinical efficacy.

关 键 词：肝细胞癌 125I 放射性粒子 D90 剂量 多因素分析 

分 类 号：R735.7[医药卫生—肿瘤]