CT引导下碘125粒子植入治疗55例腹膜后恶性肿瘤的临床观察  

CT-guided125 I seeds implantation for the treatment of malignant retroperitoneal tumor: an analysis of 55 cases

作　　者：王浩 陆建[1] 陈荔[1] 查俊豪 郭金和[1] WANG Hao;LU Jian;CHEN Li;ZHA Junhao;GUO Jinhe(Center of Interventional Radiology&Vascular Surgery,Department of Radiology,Zhongda Hospital,Medical School,Southeast University,Nanjing 210009,Jiangsu,China)

机构地区：[1]东南大学附属中大医院介入与血管外科,江苏南京210009

出　　处：《山东大学学报（医学版）》2020年第6期65-70,共6页Journal of Shandong University:Health Sciences

基　　金：国家自然科学基金(81971716);江苏省自然科学基金(SBK2019042258)。

摘　　要：目的评估CT引导下碘125(125I)放射性粒子植入治疗腹膜后恶性肿瘤的有效性及安全性。方法纳入腹膜后肿瘤患者55例,病灶69处,均为无法手术、术后复发或转移,接受CT引导下125I粒子植入治疗。术前1周内行CT检查,应用治疗计划系统勾画出肿瘤靶区轮廓,确定粒子数量、粒子空间排布方式和植入针数目。CT引导下行125I粒子植入治疗。术后每2个月随访1次,评估病灶局部控制率、疼痛缓解情况及治疗相关不良反应。结果所有病灶均成功接受CT引导下125I粒子植入治疗。首次治疗后2个月CT扫描结果显示,69处病灶中完全缓解9处,部分缓解18处,病灶稳定36处,疾病进展6处,总体病灶治疗有效率39.1%,局部控制率91.3%。术后4、6个月,总体病灶治疗有效率分别为40.6%、37.7%,局部控制率分别为89.9%、87.0%。24例患者术前存在腰背及腹部疼痛症状,术后7 d再次评估,12例(50%)患者的疼痛症状得到缓解。没有出现治疗相关的死亡事件,15例(27.3%)患者表现为术后穿刺部位疼痛,其中1例疼痛较重,给予镇痛药物治疗后缓解,其他均可自行缓解;未出现出血、肠瘘、放射性肠炎、骨髓抑制等并发症。结论CT引导下125I粒子植入治疗腹膜后恶性肿瘤是安全、有效的,对于无法手术、术后复发或转移的腹膜后肿瘤是一种挽救性的治疗措施。Objective To evaluate the efficacy and safety of CT-guided 125I seeds implantation for the treatment of retroperitoneal malignant tumors.Methods A total of 55 patients with 69 lesions,which were unresectable,postoperative recurrent or metastatic,received 125I seeds implantation under CT guidance.CT scan was performed within 1 week before the implantation.The contour of tumor target area was outlined with the treatment planning system,and the required radiation dose,number of seeds and spatial arrangement were calculated.Then CT-guided 125I seeds implantation was performed.Follow-up was carried out at an interval of 2 month to evaluate the disease control rate,pain relief rate and treatment-related adverse events.Results All operations were successful.CT images 2 months after implantation showed complete response,partial response,stable disease and progressive disease in 9,18,36 and 6 lesions,respectively.The overall response rate was 39.1%,and local control rate was 91.3%.The overall response rate was 40.6%and 37.7%,and local control rate was 89.9%and 87.0%,respectively,4 and 6 months after operation.In the 24 patients who had back or abdominal pain,12(50%)cases were relieved 7 days after the implantation.No treatment-related death occurred.Pain at puncture site was observed in 15 patients(27.3%),and only 1 patient need analgesic treatment to relieve.No complications,such as bleeding,intestinal fistula,radiation enteritis,or bone marrow suppression,were observed.Conclusion CT-guided 125I seeds implantation is safe and effective for the treatment of malignant retroperitoneal tumors.For patients with unresectable,postoperative recurrent or metastatic retroperitoneal tumors,CT-guided 125I seeds implantation may be a salvage strategy.

关 键 词：腹膜后肿瘤 125I放射性粒子 介入放射学 肿瘤介入 近距离放疗 

分 类 号：R815[医药卫生—放射医学]